BACKGROUND: Ischemic reperfusion syndrome occurs in early donor liver reperfusion after orthotopic liver transplantation. It is the most important cause for liver function failure and patient death. Ischemic reperfusion severity is closely related to blocking of inferior vena cava period. Some studies demonstrate that inferior vena retrograde perfusion can shorten the blocking time during liver transplantation. OBJECTIVE: To observe the effect of retrograde perfusion on the hemodynamics in orthotopic liver transplantation without venovenous bypass during neohepatic reperfusion phase. DESIGN, TIME AND SETTING: Case comparison was performed at Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from December 2006 to June 2007. PARTICIPANTS: Thirty-nine patients underwent orthotopic liver transplantation without venovenous bypass under general anesthesia. METHODS: According to perfusion methods, the patients were divided into two groups: retrograde perfusion through inferior vena cave (n=19), and perfusion through portal vein (n=20). MAIN OUTCOME MEASURES: The systolic blood pressure, diastolic blood pressure, heart rate, central venous pressure and other hemodynamic parameters were measured before operation, and at anhepatic phase and primary neohepatic phase. The rewarming ischemia time of grafted liver was also recorded. RESULTS: The rewarming ischemia time of grafted liver in the retrograde perfusion through inferior vena cave group was significantly less than that in the perfusion through portal vein group (P

OBJECTIVE To understand the bacterial spectrum distribution of sputum among the lung infection patients in our hospital and their resistance mechanisms for the reasonable clinical application of antibiotics to effectively prevent the occurrence of nosocomial infections. METHODS The pathogens isolated from the sputum of patients were identified with pathogen micro-biochemical identification code and the commonly used antibiotics were detected by drug sensitivity tests. RESULTS From 415 samples of the sputum,537 strains were detected out,from them Gram-positive cocci accounted for 70.8%,Gram-negative bacteria accounted for 28.1%,and Candida albicans accounted for 1.1%;MRSA was in 18 strains and ESBLs 6 strains. CONCLUSIONS It is important to sputum culturing for lung infection patients and determining the pathogen species and in their drug susceptibility results,the in order to rationally use the antibiotics and enhance the effectiveness of treatment.

Objective To investigate the nephroprotective effects of prostaglandin E1 (PGE1) in the elderly undergoing coronary angiography or intervention. Methods161 patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) were randomly assigned to PGE1 group (n=87 cases) and control group (n=74 cases).10 μg lipo-PGE1 added to 100 ml normal saline were administered intravenously once daily for 5 days before and 2 days after the operation.The serum levels of creatinine (Scr) and cystatin C (Cys C) were measured on admission and 48 h after the procedure.Results After the procedure,the levels of Scr and Cys C were increased (P＜0.01) and creatinine clearance (Ccr) was decreased (P＜0.05) in control group than in PGE1 group.The incidence of contrast-induced acute kidney injury (CI-AKI) in control group 〔12.2％ (9/74)〕 was higher than in PGE1 group 〔3.4％(3/87)〕 (P＜0.05).The application of P(GE1 decreased CI-AKI,but high basic level of Scr and diabetes mellitus enhanced the incidence of CI-AKI by logistic regression.The serum levels of Cys C had negative correlation with Ccr (r=-0.615,P＜0.01).Conclusions Perioperative application of PGE1 has nephroprotective effects in the elderly undergoing CAG or PCI,and decreases the incidence of CI-AKI.The serum levels of Cys C is one of ideal indexes for auxiliary diagnosis of CI-AKI.

Objective To evaluate the role of three vessels and trachea view (3VT) in diagnosis of fetal heart disease and great artery abnormality.Methods 39 pregnant women undergoing fetal ultrasound scan and diagnosed with great artery abnormality were enrolled in this study.Then the image characteristics and significance of 3VT in these 39 cases were analyzed and evaluated.Results In these 39 cases proved by autopsy,persistent truncus arteriosus(7 cases),transposition of the great arteries(7 cases),coarctation of the aorta(5 cases),tetralogy of Fallot (4 cases),pulmonary stenosis (3 cases),hypoplastic left ventricle syndrome(2 cases),persistent left superior vena cava (2 cases),pulmonary valve stenosis with single ventricle(2 cases),Ebstein anomaly with pulmonary stenosis (1 case),interruption of the aortic arch( 1 case),hypoplastic right ventricle(1 case),dextroaortic arch (1 case),and ductus arteriosus stenosis( 1 case) were detected.All of them had anomalies performance on 3VT.While in the 2 cases of double outlet right ventricle,only one eoncurrenting with pulmonary artery stenosis showed reduced inner diameter of pulmonary artery on 3VT.According to the performance of 3VT in great artery abnormality,it could be divided into 4 categories:abnormal location,abnormal ratio,abnormal amount and abnormal blood direction of great artery.Conclusions 3VT is a useful supplement to the 4-chamber view,and has significant value in diagnosis of fetal heart and great arteries abnormities.

Objective To investigate the expression and relationship of TIP30(HIV-1 Tat interactive protein 2), vascular endothelial growth factor (VEGF) and MVD (detected by CD34) in the angiogenesis of human brain astrocytomas. Methods Expression of TIP30, VEGF and CD34 in 19 cases of normal brain tissue and 71 cases of astrocytoma were immunohistochemically examined with Elivision plus two-step method. Results The positive expression of TIP30 could be seen in cytoplasm of neuroglial cells and neurons of 19 normal brain tissues. The positive expression rate of TIP30 in 71 cases of astrocytoma was 33.80 % (24/ 71). The positive expression rate of TIP30 in astrocytoma of different grades was 52 % for grade Ⅱ, 34.78 % for grade Ⅲ and 13.04 % for grade Ⅳ. The positive expression rate of TIP30 in high grade (Ⅲ+Ⅳ) of astrocytoma was found significantly lower than that in low grade(Ⅱ) (χ2=5.71, P <0.05); The expression of VEGF and MVD detected by CD34 in astrocytomas were higher than that in normal brain tissue and increased as the tumor grade increased; In astrocytoma, the negtive correlation was found between the expression of TIP30 and VEGF (r=-0.428, P<0.05); no correlation was found between TIP30 and MVD(r=-0.065, P 0.05); the positive correlation was found between VEGF and MVD(r=0.684, P<0.01). Conclusion The positive expression rate of TIP30 in normal brain tissue is significantly higher than that in astrocytoma. The positive expression rate of TIP30 significantly decreases as the pathological grade of the astrocytoma increases; The expression of TIP30 and VEGF is negatively correlated in astrocytoma.

Objective To evaluate the efficacy of ~(125)I radioactive seeds implantation and ~(125)I plaque brachytherapy for oral carcinoma. Methods Eighteen patients with oral carcinoma confirmed by cytology or histopathology were included in this study, Twelve patients with tongue cancer and six patients with gingival carcinoma, there were 20 ulcerative lesions and 10 metastatic cervical lymph nodes. The mean diameter is (2.3±0.7)cm and(2.8±1.7)cm respectively. The patients were treated with both interstitial implantation of ~(125)I seeds and ~(125)I plaque brachytherapy or with ~(125)I plaque brachytherapy only according to patient's individual conditions.The metastatic cervical lymph nodes were treated with CT-guided interstitial implantation of ~(125)I seeds.The sizes of ulcerative lesions and lymph nodes were observed at 1,3,6 months following treatment,and statistical analysis of the sizes of ulcerative lesions were evaluated by paired t-test.Results After 1,3,6 months follow-up,The mean diameters of ulcerative lesions were(2.1±0.6)cm(t=3.559,P＜0.01),(1.7±0.5)cm(t=7.609,P＜0.01),(0.7±0.6)cm(t=11.508,P＜0.01),the cervical lymph nodes showed reduced size. Furthermore, PET-CT images showed a significant decrease in the metabolic activity of treated tumor. After six months, the focus of infection were healing in 8 patients, the cervical lymph nodes of one patient relapsed after ~(125)I implantation again. Patients were followed for 7 to 28 months, all patients were still alive. Conclusion Interstitial ~(125)I radioactive seeds implantation and ~(125)I plaque brachytherapy provide an effective, safe treatment for oral cancer.

Objective To investigate the clinical efficacy of acupuncture at Huatuo jiaji points plus point Shixuan bloodletting in treating cervical spondylotic radiculopathy.Methods One hundred patients with cervical spondylotic radiculopathy were randomly allocated to treatment and control groups, 50 cases each. The treatment group received acupuncture at Huatuo jiaji points plus point Shixuan bloodletting and the control group, acupuncture at Huatuo jiaji points alone. Plasma viscosity was measured in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results There was a statistically significant pre-/post-treatment difference in plasma viscosity in the two groups (P<0.05). There was a statistically significant post-treatment difference in plasma viscosity between the treatment and control groups (P<0.05). The total efficacy rate was 94.0% in the treatment group and 84.0% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Acupuncture at Huatuo jiaji points plus point Shixuan bloodletting is an effective way to treat cervical spondylotic radiculopathy.

Objective:Recent studies have shown that in contrast to decrease in distal gastric adenocarcinoma (DGA), incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased noticeably in numerous counties. However, the reasons remain unclear. This study evaluated the possible differences in the expression of KLF4, SP1, and Cyclin D1 in AEG and DGA, and explored the potential carcinogenesis of AEG. Methods:Immunohistochemistry was performed on paraffin-embedded tissues to evaluate the pu-tative differences in the expressions of KLF4, SP1, and Cyclin D1 at protein level between AEG (n=58) and DGA (n=47). The patholog-ical significance of these markers between the two groups was also compared and analyzed. Results:The percentage of positive KLF4 expression was significantly lower in DGA than in AEG (P<0.05). Lower KLF4 expression was found both in well-or moderately dif-ferentiated cases and in poorly differentiated cases with DGA compared with their AEG counterparts (P<0.05). However, positive stain-ing for SP1 was significantly higher in DGA (P<0.05). No significant difference was found in the expression of Cyclin D1 between the two groups. Further analysis showed that in DGA, the positive expression of KLF4, SP1, and Cyclin D1 were significantly correlated with lymph node metastasis. In AEG, only Cyclin D1 expression was correlated with lymph node metastasis (P<0.05). No correlation was found among the expression of KLF4, SP1, and Cyclin D1 in AEG. In DGA, KLF4 was inversely correlated with SP1 and Cyclin D1 (r=-0.334 and r=-0.341, respectively, P<0.05), and SP1 was positively correlated with Cyclin D1 expression (r=0.340, P<0.05).Conclusion:Different expression patterns and clinicopathological significance of KLF4, SP1, and Cyclin D1 were observed between AEG and DGA, suggesting the putative difference in the carcinogenesis and progression of AEG and DGA.

Objective To investigate the management of retroperitoneal infected necrotic tissues in pelvic cavity in patients with severe acute pancreatitis (SAP).Methods The clinical data of 5 patients with SAP complicated with retroperitoneal infected necrotic tissue in the pelvic carvity who were admitted to the General Hospital of Nanjing Military Area from December 2009 to February 2012 were retrospectively analyzed.Systemic comprehensive treatement combined with local management were applied to all the patients.Results Systemic comprehensive treatment:all the 5 patients were treated by enteral nutrition,3 by mechanical ventilation and 3 by continuous blood purification.All the retroperitoneal infected necrotic tissues in the pelvic carvity were treated by computed tomography (CT)-guided percutaneous catheter drainage,and then the patients were converted to open surgery for further drainage.Four patients had complication of infected pancreatic necrosis bleeding,and they were treated by arterial embolism and (or) sandwich therapy.Local management:5 patients with retroperitoneal infected necrotic tissues received CT-guided percutaneous catheter drainage via buttocks.The average time of puncturation after illness was 38.4 days,and the average CT density of infected necrotic tissue was 24.4 Hu (20-28 Hu).Catheterization was successfully done in the open surgery for all the 5 patients,and the average time of abdominal drainage was 21 days.The body temperature and white blood cell count were decreased after puncturation.The average duration of intensive care unite stay,the average time of hospital stay and the average cost of hospitalization were (47 ± 20 )days,(88 ±34 )days and (186 342 ± 15 467 )yuan.All the patients were followed up till May 2012,no recurrece of the retroperitoneal infected necrotic tissue was detected.Conclusion CT-guided percutaneous catheter drainage via buttocks is effective for the treatment of retroperitoneal infected necrotic tissue in the pelvic cavity in SAP patients.

This report summarized the nursing experience of caring for twice skin grafts in a patient with enteroatmospheric fistula after trauma.Keys to nursing success including:monitoring vital signs closely to prevent septic shock,blocking enteroatmospheric fistula (EAF) and sucking overflowed intestinal juice timely,promoting the protection of the graft on abdominal wall wounds,strengthing drainage and lavage with the application of abdominal double cannula to control abdominal infection,early nutrion support with parenteral nutrition in combination with trophic enteral nutrition to improve intestinal immune function,and attaching importance to post-traumatic stress disorder.Timely blocking of EAF is the bases of skin graft healing.