Objective To discuss the technique and clinical value of laparoscopic splenectomy (LS) without using Endo-GIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2005 to October 2006, 23 patients with cirrhotic portal hypertension-induced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endo-GIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole. Results The operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonography-guided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.Conclusions It is a low-cost and superior method to disconnect the secondary splenic pedicle without using endo-GIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.

Objective To investigate the effect of acute hypervolemic hemodilution(AHHD)on the onset and recovery of muscle relaxation induced by vecuronium.Methods Thirty-two ASA Ⅰ orⅡpatients undergoing elective surgery under general anesthesia were randomly divided into 2 groups(n=16 each):control group and AHHD group.A loading dose of vecuronium 0.1 mg/kg Was given at 10 min after AHHD following tracheal intubatiom The muscular relaxation was maintained at Tl/Tc 5% to 15% by supplement with intravenous vecuroninm.Blood samples were taken at various times during AHHD for chemical analysis.The onset and recovery time of muscular relaxation were recorded.Results Compared with control group ,Hct,Hb and the concentration of TP and Alb were decreased,and the onset and recovery time of vecuronium were shortened in group AHHD(P＜0.05).Conclusion Acute hypervolemic hemodihtion can shorten the onset and recovery of muscle relaxation of vecuronium in patients under general anethesia.

Objective To explore diagnosisand treatment of intestinal obstruction by foodballs in children. Methods The clinical datum of 21 cases of intestinal obstruction by foodballs in children were retrospectively ana- lyzed.Results While admission,only 2 cases could provide the history of having eaten foodballs wholly which could not be digested easily.The characteristics of clinical manifestation were intestinal obstruction completely or incom- pletely.All 21 cases had been treated conservatively first,only one case was successful and the other 20 cases had been cured by surgery afterwords.Conclusion There is no specific feature in clinical manifestations of intestinal ob- struction by foodballs in children,so it is difficult to make the diagnosis,but it must be considered suspicious especial- ly for those from rural area and with simple intestinal obstruction with reasons not known yet.If conservative therapy is failure in a short period,an operation should be done immediately.During operation,it is necessary to examine the whole digestive system thoroughly.

Objective To discuss the protective effects of thioltransferase (TTase) on oxidative damaged human lens epithelial cells (HLEC) induced by ultraviolet radiation.Methods HLEC were cultured in vitro and then randomly divided into 4 groups:Normal group:normal cultured HLEC;UV group:normal cultured HLEC + UV radiation (with 302 nm UV radiation irradiation intensity 55.56 μW · cm-2 for 15 minutes,totaling irradiation volume 500 J · m-2);TTase siRNA group:HLEC transfected with TTase siRNA;TTase siRNA + UV group:HLEC transfected with TTase siRNA + UV radiation(with 302 nm UV radiation irradiation intensity 55.56 μW · cm-2 for 15 minutes,totaling irradiation volume 500 J · m-2).TTase mRNA expression was measured by qRT-PCR,the cell proliferation was detected by LDH Assay Kit,and the TTase activity was measured.TTase expression was detected by Western blotting.The levels of TGSH,GSH and GSSG of HLEC were measured,and then GSSG/T-GSH ratio was calculated.Results Cell proliferation ability in UV group,TTase siRNA group and TTase siRNA + UV group were decreased by 21.0％,17.0％ and 29.0％ compared with normal group (all P ＜ 0.05).TTase activity in UV group was 2.1 times of the normal group,TTlase siRNA group was 67.0％ of the normal group,Tlase siRNA + UV group was 1.3 times of TTase siRNA group (all P ＜ 0.05).TTase expression in UV group was 3.9 times of the normal group,TTase siRNA group was 35.0％ of the normal group,TTase siRNA + UV group was 3.0 times of siRNA group (all P ＜ 0.05).GSH content in UV group,TTase siRNA group and TTase siRNA + UV group were 68.4％,79.0％,61.7％ of the normal group (all P ＜ 0.05).GSSG content in UV group,TTase siRNA group and TTase siRNA + UV group were 2.3 times,1.4 times,3.7 times of the normal group (all P ＜ 0.05).GSSG/T-GSH in UV group,TTase siRNA group and TTase siRNA + UV group were 3.1 times,1.7 times,5.2 times of the normal group (all P ＜ 0.05).Conclusion TTase plays an important protective role in oxidative damaged HLEC induced by ultraviolet radiation.

Objective To compare the influence of different doses of dexmedetomidine on the haemodynamic response caused by tracheal intubation during general anesthesia induction in senile hypertension patients .Methods Sixty patients with essential hy‐pertension(EH) undergoing general anesthesia operation ,60-75 years old ,ASAⅠorⅡ ,were randomly divided into the group D1 , D2 and control group(C) ,20 cases in each group .4μg /mL dexmedetomidine in the group D1 and D2 was intravenously pumped at 15 min before anesthesia induction with the doses of 0 .2 ,0 .6 μg/kg respectively and completed within 10 min;while the group C was pumped with sodium chloride injection by the same method .Mean artery pressure (MAP) ,heart rate (HR) and O2 saturation (SpO2 ) were monitored at before medication(T0) ,before induction(T1) ,before intubation(T2) ,at 1 min(T3) ,5 min(T4) after tra‐cheal intubation .Meanwhile plasma norepinephrine(NE) and epinephrine(E) values were detected .Results Compared with before medication ,MAP before induction in the group D2 was significantly decreased (P<0 .05) ,however which in the group D1 and C had no obvious change(P>0.05);HR at 1 min after tracheal intubation in the group D2 was significantly decreased (P<0.05) , while which in the group C and D1 was significantly increased(P<0 .05) .Compared with the group C ,MAP and HR before induc‐tion and tracheal intubation ,at 1 ,5 min after tracheal intubation in the group D2 were significantly decreased(P<0.05) ,SpO2 was significantly decreased only before induction (P<0.01);MAP ,HR and SpO2 at each time points in the group D1 had no significant differences compared with the group C(P>0.05) .Compared with T0 ,the plasma levels of NE and E at T1 in the group D2 were decreased (P<0.01);the plasma levels of NE and E at T3 in the group C and D1 were increased ,while which in the group D2 were decreased (P<0.01) .The plasma levels of NE and E at T1 and T3 in the group D2 were decreased compared with the group C(P<0.01) .Conclusion Intravenous injection of dexmedetomidine can safely inhibit the tracheal intubation caused hemodynamic changes and keep the hemodynamic stabilization during general anaesthesia induction and tracheal intubation period in senile hyper‐tension patients .Furthermore dexmedetomidine 0.6μg/kg can more effectively inhibit the tracheal intubation caused stress reac‐tions than dexmedetomidine 0.2μg/kg .

Humans ; Myocardial Infarction ; pathology ; physiopathology ; Thrombosis ; pathology ; physiopathology

Congenital Abnormalities ; diagnosis ; Diagnostic Imaging ; Ear, Inner ; abnormalities ; Humans

Age-related macular degeneration (AMD) and cataract are the most common causes of low vision worldwide.Nowadays, there is still a controversy about whether cataract surgery should be taken in patients combined with AMD and when should the surgery be taken.The aim of this review is to assess the influence of cataract surgery on the occurrence and development of AMD, to analyze the risk factors, to explore the occasion of cataract surgery in patients with AMD, and joint with anti-vascular endothelial growth factor (VEGF) treatment, also including the development and application of intraocular lens.It helps to avoid and postpone the development and progression of macular degeneration after cataract surgery and get good visual outcome.

ObjectiveTo explore the early diagnostic value of pro-adrenomedullin (pro-ADM) in sepsis. Methods A prospective study was conducted. Eighty-two patients with acute infection admitted to Department of Emergency of Shanxi Medical University Second Hospital from April 2013 to March 2014 were enrolled. According to the diagnostic criteria of sepsis, the patients with acute infection were divided into ordinary infection group [infection without systemic inflammatory response syndrome (SIRS),n = 25] and sepsis group (infection combined with SIRS, n = 57). According to degree of severity of sepsis, the latter group was subdivided into three subgroups: sepsis group (n = 22), severe sepsis group (n = 27) and septic shock group (n = 8). Twenty-four healthy persons were included to serve as healthy control group. The venous blood from all the research objects in hospital was collected within 24 hours. The levels of pro-ADM and procalcitonin ( PCT ) were determined by enzyme linked immunosorbent assay (ELISA), and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was recorded. The relationship between pro-ADM and PCT and also APACHEⅡ score was analyzed with Pearson correlation analysis. The receiver-operating characteristic curve (ROC) of pro-ADM and PCT were used to evaluate the diagnostic acuity of sepsis.Results The plasma levels of pro-ADM, PCT and APACHEⅡ score in sepsis group were significantly higher than those in ordinary infection group and healthy control group [pro-ADM (ng/L): 66.69±1.73 vs. 53.43±2.70, 45.87±1.43; PCT (ng/L):1 336.49±40.26 vs. 1 083.09±47.99, 959.04±37.53; APACHEⅡ score: 14.60±0.81 vs. 8.10±1.14, 3.00±1.15,allP< 0.01]. With the aggravation of sepsis, the levels of pro-ADM, PCT and APACHEⅡ score were gradually increased, and there were significant differences among sepsis, severe sepsis, and septic shock groups [pro-ADM (ng/L): 64.91±2.50, 73.56±2.80, 84.67±4.52; PCT (ng/L): 1 152.65±48.62, 1 233.93±63.06, 1 475.71±109.93;APACHEⅡ score: 12.91±1.15, 14.55±1.14, 19.37±2.40,P< 0.05 orP< 0.01]. Pearson correlation analysis results showed that the level of pro-ADM was positively related with PCT (r = 0.473,P = 0.006), and it was also positively correlated with APACHEⅡ score (r = 0.707,P = 0.008). ROC curve analysis showed that area under the ROC curve (AUC) of pro-ADM for diagnosis of sepsis was 0.823 (P = 0.003). When the cutoff value was 59.40 ng/L, the sensitivity was 80.7%, the specificity was 68.0%, the positive predictive value was 85.2%, and the negative predictive value was 60.7%. AUC of the PCT for diagnosis of sepsis was 0.653 (P = 0.043). When the cutoff value was 1 194.67 ng/L, the sensitivity was 68.4%, the specificity was 64.0%, the positive predictive value was 81.8%, and the negative predictive value was 44.7%. It was proved that the pro-ADM had a higher diagnostic value for sepsis than PCT.Conclusion The plasma levels of pro-ADM can be used as an early indicator in diagnosis and severity evaluation and prognosis in patients with sepsis .

Objective To explore the value of neopterin (Np) in early diagnosis and risk stratification of sepsis.Methods A total of 82 patients admitted to the emergency department from April 2013 to February 2014 were enrolled in the study.They were divided into two groups:sepsis-free group (n =8) and sepsis group (n =74).Patients' APACHE Ⅱ scores were calculated within 24 hours after admission,and then their plasma levels of Np and procalcitonin (PCT) were detected and analysis was carried out to find the correlation between plasma levels of Np,PCT and acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ score) in two groups.And 74 patients in sepsis group were further divided into three subgroups according to their APACHE Ⅱ score:Ⅰ subgroup (score ＜ 15,n =27),Ⅱ subgroup (score 15 to 24,n =32),and Ⅲ subgroup (score ＞ 25 or more,n =15).The differences in plasma Np and PCT levels were compared among three subgroups and correlation analysis of Np levels with PCT levels and APACHE Ⅱ scores was carried out.Results The plasma levels of Np,PCT and APACHE Ⅱ scores in sepsis group were higher than those in sepsis-free group (P ＜ 0.05).In sepsis group,the plasma levels of Np and PCT were gradually increased with the increasing severity of sepsis (P ＜ 0.05);In sepsis group,the plasma levels of Np,PCT and APACHE Ⅱ scores were positively correlated (P ＜0.01).The area under receiver operating characteristic curve (ROC) of Np was O.79 and the area under ROC of PCT was 0.75,both of which had high diagnostic accuracy.Conclusions Neopterin has greatly useful value in early diagnosis and risk stratification of sepsis.