Objective To evaluate the value of different methods of hormone measurement and image study before surgery.Methods We retro spectively reviewed 99 patients with insulinoma confirmed by pathological report after surgery in the PUMC Hospital from December 1989 to August 2005.Results The main clinical manifestations were hypoglycemia coma,weight gain,perspiration,disorientation,hypomnesis,and dizziness.The sensitivity of diagnosis of insulinoma with fasting blood-glucose less than 2.78 mmol/L was 66.6%.The ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks was 90% sensitive.The sensitivity of perfusion CT was highest which was 100%.Conclusion Typical “Whipple's triad” and the ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks are best for the qualitative diagnosis of insulinoma.Perfusion CT has the best sensitivity and specificity among image studies currently used.

Objective To evaluate nasal carriage and antimicrobial resistance of bacteria in health care workers (HCWs)in an intensive care unit (ICU),and provide basis for making prevention and control measures of health-care-associated infection(HAI).Methods From April 2014 to March 2015,nasal swabs from HCWs in ICU were collected,carriage and antimicrobial resistance of bacteria were detected.Results A total of 450 nasal swab speci-mens were taken,137 strains were isolated,isolation rate was 30.44%.There were no significant difference in na-sal carriage rates of bacteria in HCWs with different genders,ages,types of work,length of service,and education-al level (P >0.05);nasal carriage rates in HCWs at different seasons were significantly different (P <0.05 ).82 strains (59.85%)were gram-negative bacteria,the major were Klebsiella pneumoniae (21 .16%)and Enterobacter aerogenes (18.98%);55 strains (40.15% )were gram-positive bacteria,the major were Staphylococcus aureus (18.98%)and Staphylococcus epidermidis (15.33%).38 (27.74% )strains were multidrug-resistant strains. 7.69% (2/26)of Staphylococcus aureus were methicillin-resistant strains,3.45%(1/29)of Klebsiella pneumoniae and 3.85%(1/26)of Enterobacter aerogenes were imipenem-resistant strains.Conclusion Nasal carriage rate of bac-teria and detection rate of multidrug-resistant organisms in HCWs in ICU is high.

To study the clinical efficacy of Pihui Fanggan Sachet (PHFGS), a sachet of traditional Chinese herbs, in preventing influenza and its immune regulation on mice.

Objective To compare clinical effects and complications of patients with diabetes in off-pump coronary artery bypass grafting(OPCAB) between endoscopic saphenous vein harvesting(EVH) and conventional saphenous vein harvesting(CVH).Methods Sequence comparison analysis the clinical data of 339 patients with DM who underwent OPCAB in our department from Nov 2011 to Nov 2014.269 cases by EVH,70 cases by CVH.Observing two groups of patients with deprecated rate of SVG,intraoperative SVG blood flow and the value of PI,lower limb wound complications such as incision infection,poor healing,lower limb local hematoma and pain.SVG patency rate of part patients was follow-up by CT coronary angiography.Results To compare the two groups of patients by EVH and CVH,the perioperative death was 8 cases in EVH group (2.4％),2 cases in C VH group (2.9％).The deprecated SVG of patients was 3.9％ vs 2.9％.The blood flow was (17.36 ±11.24) ml/min vs(17.11 ± 8.37) ml/min,PI was 2.78 ± 2.37 vs 2.22 ± 2.17.The incision infection was 0 vs 4.4％,poor healing was 0.9％ vs 8.8％.The lower limb local hematoma was 5.7％ vs 1.5％.The visual pain analogue scale(VAS) was 0.53 ± 1.71 vs 1.26 ± 2.13 3 days after operation.The numbness of lower limb was 9.7％ vs 22.1％.The Edema of the legs was 8.5％ vs 19.1％ 7 days after operation.60 cases were follow-up by CT coronary angiography,the SVG patency rate was91.4％ vs 94.6％ 1 year after operation,83.3％ vs 86.1％ 2 years after operation,72.2％ vs 73.7％ 3 years after operation respectively.Conclusion EVH technology for SVG in the patients combined DM has good clinical result,the recent patency rate of SVG is perfect,postoperative limb complications is decreased by EVH.

OBJECTIVETo provide a scientific basis for systematic research on the mechanism of chronic immobilization stress (CIS) induced metabolic network change in rats, through detecting the changes of endogenous metabolites in rats with CIS, treated or un-treated with Xiaoyao Powder (XYP), for determining the small molecule marker compound that closely associated with the metabonomical specificity of CIS and acting mechanism of XYP.

METHODSThirty-six experimental male SD rats were divided into 3 groups, the normal control group, the model group and the XYP group. And all the three groups were subdivided into two subgroups respectively on day 7 and day 21 of the experiment. The stress rat model of CIS was made by chronic restraining method for 3 h every day. Starting from the first day of modeling, XYP 3.854 g/kg in volume of 1 mL/100 g body weight was administered 1 h before restraining via gastrogavage to rats in the XYP group, while equal volume of distilled water was given to rats in the other two groups instead. Blood samples were collected on the 8 th day and 22 th day for detection in the following procedure: at 27 degrees C, 300 microL supernate of blood plasma was taken, calling the Carr-Purcell-Meiboom-Gill (CPMG) and longitudinal eddy-delay (LED) sequence respectively on a Fourier variable nuclear magnetic resonance (NMR) spectrometer, pre-saturated inhibition of the water peak was performed; free induction decay (FID) signals were transferred via 32 k Fourier transformation to gain one-dimensional NMR spectrogram; by taking TSP as the chemical migration reference peak, the segmental integral calculus (0.04 ppm per segment) was performed from 4.5 - 0.5 ppm (CPMG) and 6.0 - 0 ppm (LED) within the peak ranges in 1H spectra using the VNMR software; after normalization, centering and scaling were conducted on data, then used for pattern recognition of principal component analysis (PCA) using the SIMCA-P 10.0 software, or if necessary, the partial least squares discriminate analysis (PLS-DA) was performed.

RESULTS(1) The metabolites in the model group were significantly different from those in the control group, suggesting that the animal model was successfully established with the metabolic network different to that of control. The model group and the XYP group could be differentiated from the control group by the differences of metabolites and metabolic networks between groups; XYP could intervene the metabolites or the metabolic path to cause changes in final metabolites. (2) The serum contents of lactic acid (1.4, 4.16), choline (3.24), N-acetylgalactosamine (NAC) and saturated fatty acids (1-3) increased, but unsaturated fatty acids (1.99,4-5), blood sugar (34), HDL (0.83), etc. reduced in the CIS rats. XYP showed obvious regulatory effects on final metabolites, causing decrease of lactic acid, choline, NAC, saturated fatty acids and blood sugar, and increase of unsaturated fatty acids, blood sugar, HDL, 3.44 ppm compound, etc.

CONCLUSIONSThe metabolic phenotype in CIS rats includes the increase of lactic acid, choline, NAC, saturated fatty acid, and the decrease of blood sugar contents, unsaturated fatty acid, HDL, 3.44 ppm compound, etc., these may be the markers of the metabolites. The final metabolites changes induced by CIS are primarily the lipid substances. XYP markedly regulates the contents of final metabolites, showing the regulatory effects on final metabolites, but what is the metabolite or metabolic pathways it interferes to alter the final metabolites should be confirmed by further studies.

Animals ; Blood Chemical Analysis ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Metabolomics ; Powders ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Stress, Physiological ; drug effects

Objective To evaluate the effects of different levels of neuromuscular blockade(NMB)on transcranial electric motor-evoked potentials(TCeMEPs)during idiopathic scoliosis.Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 11-23 yr,weighing 31-62 kg,scheduled for elective idiopathic scoliosis under general anesthesia,were enrolled in the study.NMB was monitored with train of four(TOF)-Watch SX.The levels of partial NMB were classified into 5 states according to TOF ratio(TOFR)and TOF counts:1 or 2 TOF counts(TOF1),3 TOF counts and TOFR≤15%(TOF2),TOFR 16%-25%(TOF3),TOFR 26%-50%(TOF4),TOFR 51%-75%(TOF5) and TOFR>75%(no NMB).Each state was maintained for 10 min.Failure and false-positive findings in TCeMEP monitoring,development of unexpected body movement and satisfaction with NMB were recorded.Results Compared with no NMB,the failure and false-positive rates of TCeMEP monitoring were significantly increased,the incidence of unexpected body movement was decreased,and the rate of satisfactory NMB was increased at TOF1,TOF2 and TOF3(P<0.05),no significant change was found in failure or false-positive rates of TCeMEP monitoring at TOF4 and TOF5(P>0.05),and the incidence of unexpected body movement was decreased and the rate of satisfactory NMB was increased at TOF4,the rate of satisfactory NMB was increased at TOF5(P<0.05),and no significant change was found in the incidence of unexpected body movement at TOF5(P>0.05).Compared with those at TOF4,no significant change was found in the failure or false-positive rates of TCeMEP monitoring(P>0.05),the incidence of unexpected body movement was significantly increased,and the rate of satisfactory NMB was decreased at TOF5(P<0.05).Conclusion Maintaining TOFR at 26%-50% the partial NMB during surgery does not affect TCeMEP monitoring during idiopathic scoliosis and meets the intra-operative NMB requirements simultaneously,and it is the optimum NMB for this type of surgery.

ObjectiveTo explore the ideal minimally invasive surgical method for degenerative lumbar spine stenosis.MethodsFrom March 2008 to August 2010,73 cases with lumbar spinal stenosis underwent minimal invasive surgery were retrospectively analyzed.The patients were divided into different groups by clinical features,imaging manifestations,and concurrent diseases.The minimal invasive surgical methods were chosen according to the classification.Operation time,intra-operative bleeding,and complications were recorded.The lumbar function was evaluated by Oswestry disability index (ODI),and the clinical results were assessed by JOA pre- and postoperatively.ResultsMinimal invasive surgery was completed in all cases,which included 25 cases with bilateral decompression and 48 cases with unilateral approach for bilateral decompression.Twenty-three cases used interbody fusion and percutaneous pedicle screw fixation after decompression.Intraoperative blood loss and operation time were related to surgical methods.One case was complicated with dural tear.Cage was inserted into upper vertebral body during interbody fusion in 1case with osteoporosis,removed the cage and implanted bone fusion.Incisions of 3 cases were poor healing after surgery.The average follow up time was 13 months(range,10-35).JOA score and ODI before surgery were 9.2±5.1 and 62.3％±18.5％ respectively; while 6 months after surgery,JOA score and ODI were 23.5±7.2 and 18.4％±6.4％ respectively.JOA score and ODI showed statistically significant improvements after operation(P＜0.01).Twenty-two cases got solid fusion at the final follow-up.ConclusionTreatment of lumbar spinal stenosis by minimal invasive surgery has satisfactory surgical outcomes,but the proper minimal invasive strategy should be chosen according to specific patients,surgeons and hospitals.

OBJECTIVETo observe the clinical efficacy and safety of Tiaozhi Yanggan Decoction (TZYGD) in treating non-alcoholic fatty liver.

METHODSOne hundred and thirty-eight patients were enrolled and randomized into two groups according to the random number table in a ratio of 3:1, with 8 cases eventually dropping out. The symptoms, signs, liver function markers, blood lipids, iconographic indices and clinical comprehensive efficacy after a 12-week treatment course were assessed in 101 patients treated with TZYGD in the treated group and 29 patients treated with Thiola in the control group.

RESULTSThe total effective rate in the treated group and the control group was 81.19% and 68.97%, respectively, showing a significant difference between the two groups with the former being significantly higher than the latter (P<0.05). Moreover, the improvements in the symptoms, signs, liver function, blood lipids and iconographic indices in the treated group were favorable with no serious adverse reactions.

CONCLUSIONTZYGD is effective and highly safe in treating non-alcoholic fatty liver.

Adult ; Body Mass Index ; Body Weight ; drug effects ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Fatty Liver ; blood ; drug therapy ; physiopathology ; Female ; Humans ; Lipids ; blood ; Liver ; physiopathology ; Male ; Medicine, Chinese Traditional ; adverse effects ; methods ; Middle Aged ; Phytotherapy ; adverse effects ; Treatment Outcome

OBJECTIVETo evaluate protein loss in critically ill patients with acute renal failure during continuous veno-venous hemofiltration (CVVH) and analysis the major factor impacting protein clearance.

METHODSA analysis was carried out in eighteen (twelve male and six female) sepsis or severe acute pancreatitis patients with acute renal failure from September 2008 to September 2009. The average age was 45 years (39 - 62 years). CVVH was conducted for 24 h in all patients. Effluent volume, blood speed, ultrafiltration rate and transmembrane pressure (TMP) were 4000 ml/h, (277 ± 89) ml/h, (179 ± 4) ml/min and (173 ± 48) mm Hg (1 mm Hg = 0.133 kPa) respectively. Blood samples were collected before and after filtration in order to detect protein concentration. Ultrafiltrate was obtained hourly to measure protein concentration and calculate protein loss during session.

RESULTSMean protein concentration was (231 ± 67) mg/L and protein loss was (22 ± 6) g/d in ultrafiltrate samples. The difference in serum protein level during hemofiltration was not significant [(56 ± 6) g/L vs. (55 ± 10) g/L, P > 0.05], while there was a weak, but statistically significant correlation between the ultrafiltrate protein concentration and the corresponding value for serum protein (r = 0.481, P < 0.05). However, there was a strong and statistically significant correlation between the ultrafiltrate protein concentration and the TMP (r = 0.564, P < 0.01). Stepwise multiple regression analysis showed that TMP and serum protein concentration played a pivotal role in ultrafiltrate protein loss.

CONCLUSIONSIn addition to renal replacement therapy, serum protein would be cleared through hemofilter during CVVH. TMP and serum protein concentration are the main factors that affect protein loss in ultrafiltrate. As a result, it is necessary to take account of the protein loss in ultrafiltrate when setting nutritional schedule.

Acute Kidney Injury ; therapy ; Adult ; Blood Proteins ; deficiency ; Critical Illness ; Female ; Hemofiltration ; adverse effects ; Humans ; Male ; Malnutrition ; etiology ; Middle Aged

OBJECTIVETo prepare cryptotanshinone (CT)-cyclodextrin inclusion compound and improve dissolution of CT.

METHODInclusion ratio was determined by plotting the phase solubility curve of CT versus hydroxypropyl-beta-cyclodextrin (HPCD). CT-cyclodextrin inclusion compound was made by wet grinding method. Properties of the inclusion compound was investigated by in vitro dissolution test, DTA and IR spectrum.

RESULTInclusion ratio of CT versus HPCD was 1:1. Dissolution of CT-HPCD inclusion compound at 45 min was 21.6 times of material drug.

CONCLUSIONDissolution of CT was improved remarkably in CT-HPCD inclusion compound. The complexation force of the inclusion compound was hydrogen bond formed by carbonyl group of CT and hydroxyl group of HPCD.

2-Hydroxypropyl-beta-cyclodextrin ; Biological Availability ; Drug Carriers ; Drugs, Chinese Herbal ; chemistry ; Phenanthrenes ; chemistry ; isolation & purification ; Salvia miltiorrhiza ; chemistry ; Solubility ; Technology, Pharmaceutical ; methods ; Time Factors ; beta-Cyclodextrins ; chemistry