Objective To explore the cause and effective management and prevention of septic shock after minimally invasive percutaneous nephrolithotomy (MPCNL) in the elderly.Methods Clinical data of 13 patients with septic shock after MPCNL in our hospital were retrospectively analyzed,and the cause,prevention and treatment of septic shock were investigated.Results The incidence of septic shock in patients undergoing MPCNL was 3.54％ in this study.Single-factor analysis and logistic regression analysis showed that the risk factors for post-MPCNL septic shock were female and the history of diabetes (both P＜0.05).Conclusions Septic shock is a serious complication after MPCNL.Intensive perioperative prevention measures can reduce the incidence of septic shock.Early diagnosis and proper treatment are the keys to successful treatment of septic shock.

Objective To analyze and investigate clinical characteristics, pathogenesis and treatment of urinary tract infection and aseptic meningitis. Methods Clinical features and laboratory tests of a two-month-old baby girl with urinary tract infection and aseptic meningitis were reported. Results The patient complained of fever, neck stiffness and a bulging fontanel, accompanied by congestion and abnormal secretion of urethra. The cerebrospinal lfuid (CSF) white blood cell count was 30×106/L. The blood culture and the CSF culture were both negative. And the urine culture was positive for Enterococcus faecium. The patient received a 10-day course of intravenous antibiotic therapy. The prognosis is good with no recurrence of the disease. Conclusions Aseptic meningitis can be concomitant with urinary tract infection, The probable hypothesis may be that sterile CSF pleocytosis is mediated by urinary tract infection. Knowledge of this may prevent unnecessary antibiotics therapy for presumed bacterial meningitis.

Objective To estimate fairness in the financial contributions of suburban households of Shanghai to the health system and the situation throughout the country. Methods A household survey was conducted to obtain data on health expenditure and government health input, which was then analyzed by means of the index for and methodology of fairness in the financial contributions of households in the performance assessment of the health system as introduced by the WHO. Results The coefficient of fairness in the financial contributions of households to the health system was estimated to be 0.735 and the rate of cooperative medical care coverage was positively related to the fairness. Conclusion The fairness level of the financial contributions of suburban households of Shanghai to the health system tallies with the level estimated by the WHO for China while the national level is lower. The calculations of government subsidy for household health, as recommended by the WHO in estimating fairness in the financial contributions to the health system, do not conform to the actual situation in China.

Based on the results of oral glucose tolerance test( OGTT )and the levels of 1-h plasma glucose ( 1 hPG),793 subjects were classified into three groups:583 with NGTN ( normal 1 hPG in OGTT),127 with NGT1 H( higher 1 hPG in OGTT) and 83 with IGT( impaired glucose tolerance).NGT1H group had large waist circumference,higher body mass index,fasting plasma glucose( FPG),triglyceride,and lower high density lipoprotein-cholesterol than those of NGTN group.NGT1 H group had higher homeostasis model assessment insulin index ( 1.2 ± 0.6),lower homeostasis model assessment β3 ( HOMA-β ) (4.5 ± 0.7 ) and insulinogenic index (2.1 ±0.7) than those of NGTN group(0.5 ±0.6,4.8 ±0.7,2.7 ±0.9,respectively,all P ＜0.05 ).HOMA-β of NGT1 H group was higher than that of IGT group(4.5 ±0.7 vs.4.4 ±0.6,P ＜0.05 ).The results indicate that 1 hPG in OGTT may identify a condition of glucose metabolic abnormalities characterized by insulin resistance and reduced β-cell function.

BACKGROUND:Amputation is a special type of trauma. Mechanism of trauma-induced damage to the liver and the effects of hydrogen sulfide (H 2 S) on the liver remain unclear.
OBJECTIVE:To explore the mechanism of hepatic damage in rats of postoperative amputation, and how H 2 S exerts effects on liver function.
METHODS:Wistar rats and Sprague-Dawley rats were equal y and randomly divided into normal group, postoperative 6-, 12-, 24-and 72-hour groups, sodium hydrosulfide (NaHS) group, and propargyl glycine group, as wel as normal group, postoperative 6-hour group, HaHS group, and propargyl glycine group. Except the normal group, the structure 1.2-1.4 cm above the left knee was completely transected in rats of other groups. Blood vessels were ligated, and then left femoral vein and femoral artery were cut to establish rat models of amputation in the left hind limb. In the NaHS and propargyl glycine groups, 28 μmol/kg NaHS and 50 mg/kg propargyl glycine were intraperitoneal y injected immediately after amputation.
RESULTS AND CONCLUSION:Compared with the normal group, traumatic changes in rat liver cel s and mitochondrial structure were seen, and plasma and liver myeloperoxidase, malondialdehyde, H 2 S/cystathionineγ-lyase levels, liver mitochondrial respiratory control rate, membrane potential and ATP activity were significantly lower in the postoperative 6-hour groups (P<0.05). After NaHS intervention, H 2 S/cystathionineγ-lyase level and above indicators were significantly higher in the postoperative 6-hour groups (P<0.05), but plasma transaminase did not significantly alter (P>0.05). After treatment with propargyl glycine, above indicators except mitochondrial indexes were further decreased, and transaminase was significantly reduced (P<0.05). These findings suggest that H 2 S can reduce lipid peroxidation, inflammatory reaction, and make the mitochondrial function improved significantly, but did not reduce the damage of liver function in rat models after amputation.

Objective To investigate the effects of Triptolide on apoptosis of cultured rat mesangial cells treated by TGF-β1 and the role of Smac in this process. Methods The mesangial cells were pre-treated with different concentrations of Triptolide for 24 hours, then stimulated with TGF-β1 for 24 hours. Apoptotic cells were detected by TUNEL assay. Smac transcription level was determined by Real time-PCR analyses. Smac expression level was assessed using Western blot anal-yses. Localization of Smac was shown by confocal fluorescence microscopy. Results Compared with control group, TGF-β1 inhibited apoptosis and Smac transcription and expression in rat mesangial cells. By contrast, Triptolide promoted mesangial cells apoptosis. In Triptolide groups, Smac mRNA and protein levels were up-regulated. Additionally, in normal and TGF-β1 groups Smac protein was mainly localized in mitochondriawhile in Triptolide groupit was mainly localized in cytoplasm and nucleus with increased fluorescence intensity. Conclusion Triptolide could promote the effect that TGF-β1 inhibited apop-tosis of mesangial cells, through both up-regulation the expression of Smac and stimulating it translocation from mitochon-dria to cytoplasm and nucleus.

Objective To evaluate the clinical features of osteoarticular damage of patients with brucellosis,and to enhance the knowledge of clinical doctors.Methods The demographic characteristics,clinical presentations,accessory examination of 265 patients with brucellosis admitted from January 2011 to April 2014 in Ji'nan Infectious Diseases Hospital were retrospectively analyzed.Patients were classified into two groups:Patients with osteoarticular complications and patients without osteoarticular complications.Results Of the 265 patients,forty-six patients (17.36％) had osteoarticular complications.Spondylitis was the most common complication [50.00％ (23/46)],followed by sacroiliitis [41.30％ (19/46)] and peripheral arthritis [26.09％ (12/46)].Sacroiliitis was more common than other types of osteoarticular damage in females [21.74％ (10/46)],whereas in males spondylitis was more common [36.96％ (17/46)].Peripheral arthritis was more common in individuals under the age of 17 years old [4.35％ (2/46)],and sacroiliitis were more common in the ages of 18-60 years old group [23.91％(11/46)] and spondylitis were more common in over 60-year age group [30.43％ (14/46)].Patients with osteoarticular complications showed longer duration of illness from the onset of the symptoms to its diagnosis (median 45 days),compared to those non-osteoarticular brucellosis (median 30 days,Z =5.74,P ＜ 0.05).Conclusion Due to diversity of osteoarticular damage in patients with brucellosis,in case of a patient with long-term fever and osteoarticular symptoms,medical and epidemiological history should be inquired so as to strengthen early diagnosis and treatment of the disease based on combination with radiological findings.

Objective To study the effects of joint optimization of CT scanning?modes and CTA starting?modes on the image quality, the patients' radiation doses and contrast volumes in cervicocerebral CTA. Method According to the date of examination from December 2013 to January 2014, 188 consecutive patients were prospectively selected and underwent cervicocerebral CTA using different CT scanning?modes and CTA starting?modes. These patients wererandomly divided into 4 groups:A1 (45 cases), A2 (48 cases), B1 (45 cases) and B2 (50 cases). Group A1 were Flash mode combined with test bolus, Group A2 were Flash mode combined with bolus tracking, group B1 were the common spiral scanning mode combined with test bolus and group B2 were the common spiral scanning mode combined with bolus tracking. The objective image quality evaluation criteria included the CT value comparison at the aortic arch (Pa1), carotid artery bifurcation (Pa2), basal artery (Pa3), superior vena cava (Pv1), internal jugular (pv2), transverse sinus (Pv3) and image objective noise. The subjective image quality assessments criteria included the contrast hardening artifact and diagnose acceptability. The radiation dose and contrast volumes of every patient were recorded and analyzed. The analysis of variance, the chi?square tests and the rank sum tests (Kruskal?Wallis) were used for data statistics. Results There were significant differences on the CT value at transverse sinus among the four groups, they were (124±30), (151±34), (130±37) and (160±37) HU, and different starting?modes had impacts on venous reflux (P<0.05), while scanning modes did not (P=0.162). There was no significant differences on the CT values at the other points among the four groups (P>0.05). The image noise had significant differences in four groups (P<0.05), the noise in Flash mode of dual?source CT were bigger than in the common spiral scanning mode. There was no statistically significant difference on diagnosis acceptability (P>0.05), however there were significant differences on contrast hardening artifacts (P<0.05) among the four groups. With the same scanning mode, the artifacts of group A1 were more serious than A2 and B1 were more serious than B2.There were significant differences on the patients' contrast volumes in the four groups (P<0.05), they were (45±5), (49±4), (35±4) and (35±4) ml, the contrast volumes in groups A1 and B1 were more than groups A2 and B2. There were significant differences among the four groups on patients' ED (P<0.05), which were (0.79 ± 0.07), (0.81 ± 0.08), (1.49 ± 0.11) and (1.51 ± 0.12) mSv. The radiation dose in groups A1, A2 were lower than those in B1 and B2. Conclusion The joint use of Flash mode and bolus tracking technique is recommended in application of cervicocerebral CTA, for its advantages of better image quality, good diagnosis acceptability, the patient's low radiation dose and low contrast volumes.

OBJECTIVE:To select a technique for preparation of fluconazole for injection and to establish a method for determination of its content.METHODS:The formula was selected on the basis of pH value and species of solution adjuvant.The content was determined by HPLC.RESULTS:The preparation was stable when pH value was between6.5～8.5,and its clarity could be increased by propylene glycol.The detectable concentration of fluconazole showed a good linear correlation in the range of40～200?g/ml.The average recovery was100.37%,RSD=1.37%(n=3).CONCLUSION:The fluconazole for injection prepared by the present technique is stable in quality and the method for content determination is accurate and practicable.

Objective To explore the changes of expression of tight junction protein occludin in the brain microvascular endothelial cells of rats with acute necrotizing pancreatitis (ANP), and to study the relationship between the occludin expression and degree of pancreatic pathologic changes. Methods 80 rats were randomly divided into sham-operation (SO) group and ANP 3 h, 6 h, 12 h, and 24 h groups. Retrograde pancreatic duct injection of 5% choleate sodium in rats was used to establish ANP models. Pancreatic pathologic changes was evaluated. Immunohistochemistry, Western blot and RT-PCR were used to determine the expressions of the tight junction protein occludin in the brain microvascular endothelial cells. Results Occludin protein was linearly expressed along brain vascular vessels. The expression of occludin protein at 3h was 0. 35±0.09 in brain tissues from rats with ANP and 0. 49±0.08 in SO group, the expression of occludin mRNA were decreased from 1.50±0.30 to 1.01±0.18 (P < 0.05), the lowest expression rate occurred at 6 h, and the values in the two groups were 0. 26±0.07 and 0. 93±0. 19, respectively, the expressions of occludin protein and mRNA of ANP group at 12 h, 24 h were notably increased when compared with those at 6 h (P < 0. 05), but they were still lower than those in SO group (P < 0.05). The occludin protein and mRNA expressions were negatively related with the degree of pancreatic pathologic changes (Pearson correlation coefficient: -0.48 and -0.536, P < 0.05). Conclusions The expression of tight junction protein occludin decreased at both protein and mRNA level in brain microvascular endothelial cells of ANP rats. Furthermore, the expression of occludin was negatively correlated with pathological change of pancreas.