Objective To estimate the prevalence of erectile dysfunction (ED) among the patients undergoing manintenance hemodialysis (MHD), and evaluate the efficacy and the adverse effects of sildenafil for ED. Methods The international index of erectile function questionnaire (IIEF) was used to estimate 22 male MHD cases. ED patients were administered sildenafil with the initial dose of 25 mg/d, then maximum of 100 mg/d for 12 weeks. Results 72. 73% (16/22) of MHD patients complained of ED, and the total effective rate of sildenafil was 87.5% (14/16) with common adverse effects-headache and flushing. Conclusion Sildenafil in MHD patients has similar efficacy and safety as the others.

Objective To evaluate the safety and efficacy and explore the clinical application value of the enhancement controlla-ble output channel narrowed ileal bladder suspension surgery and traditional ileal neobladder after total cystectomy.Methods From January 2001 to August 2009,42 patients with bladder cancer received enhancement controllable output channel narrowed ileal blad-der suspension surgery after total cystectomy;and 46 patients received ileal neobladder after total cystectomy.Their clinical data, perioperative situation,postoperative complications and tumor progress were analyzed.Results In regard to the blood loss,postop-erative hospital stay,and postoperative recent or far complications,both surgical methods had no significant statistical difference (P >0.05).The group of Enhanced controllable output channel narrowing ileal bladder suspension surgery was good control of uri-nation after operation(P <0.05).Conclusion Enhancement controllable output channel narrowed ileal bladder suspension surgery has good clinical effect and safety.It is especially suitable for the patients who need control inurine and don′t accepted orthotopic neobladder.

For a matured digestive surgeon,pancreaticoduodenectomy (PD) is regarded as one of the most complicated and technically challenging surgical procedure.Based on the accurate interpretation of patient's preoperative imageologic data,we advocate a novel procedure which is called as G-path pylorus-preserving pancreatoduodenectomy (G-path PPPD).We deen G-path PPPD as a standardized procedure for resectable pancreatic head cancer or periampullary carcinoma,which definitely simplify the procedure,save the operative time,achieve R0 resection through en-bloc resection without interruptedly intraoperative exploration and reduce the risk of iatrogenic tumor metastasis.This article introduced the program of G-path PPPD in detail by taking a patient as an example who suffered from pancreatic head cancer accompanied with obstructive jaundice,and discussed the relevant points.

Background and Purpose:Cyclooxygenase-2(COX-2) plays an important part in tumor genesis,growth,and angiogenesis.Many inhibitors of COX-2 could inhibit proliferation and induce apoptosis of cancer cells. This study investigated the impact of NS398 on anti-proliferation and the induction of apoptosis in human osteosarcoma cell line MG-63.Methods:Cell proliferation is measured by MTT method.Characteristic changes of apoptosis in morphology are observed by fluorescence microscopy、transmission electron microscopy(TEM) and quantitatively by TDT-mediated dUTP-biotin nick end-labeling(TUNEL) assay.The apoptotic rates are calculated by flow cytometry(FCM).Results:The growth inhibition rates of MG-63 cells treated with 1,10,50,100 and 200 ?mol/L NS398 are 14.7%,23.5%,33.6%,52.5% and 81.4%,respectively(P

Objective To investigate the clinical features of internal carotid steal syndrome. Methods The clinical manifestations, CT or MRI, digital subtraction angiography, and blood flow compensation in 6 patients with internal carotid steal syndrome were analyzed. Results Of the 6 patients, 2 had unilateral internal carotid artery stenosis, 4 had severe stenosis (in which 2 were on the left side, 1 was on the right side, and 1 was on both sides). The clinical manifestations of the patients with internal carotid steal syndrome were watershed infarction and transient ischemic attack. Four patients had posterior circulation ischemia and 2 had anterior circulation ischemia. Digital subtraction angiography demonstrated that collateral circulation was established in all the 6 patients. The anterior communicating artery, posterior communicating artery, and pial artery were the common compensatory vessels. Conclusions Internal carotid artery steal syndrome can be presented as anterior or posterior circulation ischemia, and the collateral circulation plays an important role in the compensation.

Objective To evaluate the feasibility and the effect of the early postoperative enteral nutrition on improving the nutritional status, cost of nutrition and hospital stay after operation in abdominal surgery.Methods 48 patients who underwent abdominal operation were allocated into 2 groups: enteral nutrition group(EN group,23 cases) and parenteral nutrition group(PN group,25 cases). It was isonitrogenous and isocaloric intake in both groups. Each day nitrogen intake (0.18±0.02)g/kg,104.6—125.52 kJ(25—30kCal/kg). EN was given at postoperation 8 hours by naso intestinal tube which was placed 30 cm distal to ligament of Treitz or jejunal export loop. PN was provided by peripherally inserted central venous catheters(PICC). The nutritional indices were investigated. A visual analogy scale was used to estimate the infection related complication, cost of nutrition and hospital stay. These parameters were evaluated preoperatively and on the 8th day after operation.Results Early postoperative enteral nutrition showed significant nutrition effect in the patients undergoing abdominal surgery. In the EN group,the nitrogen balance became positive at the postoperative day 4,whereas the nitrogen balance still remained negative in the PN group. The EN group decreased their hospital stay and cost of nutrition compared with that of the PN group(P<0.05). Conclusion The early postoperative enteral nutrition is safe and feasible. It cannot only improve the nutritional status and intestinal function obviously, but also decreased the hospital stay and cost of nutrition compared with parenteral nutrition.

Objective To observe the effect of treating Diabetic Peripheral Neuropathy with Acupoint Injection. Methods 65 patient with DPN were randomly recruited into a control group and a treatment group after adjusting stage. The control group was treated with acupuncture, while the treatment group was treated with the Safflower inoculation fluid acupuncture point injects. Nerve function parameter (MDNS、 NCV) and clinical symptoms were observed after 3 therapeutic courses. Results Nerve function parameter (MDNS、 NCV) and clinical symptoms in the treatment group were apparently improved after treatment (P<0.05) . Conclusion Acupuncture point injected with Safflower inoculation fluid may improve clinical symptoms and nerve functions of DPN patients.

Objective To summarize the initial experience in adult-to-adult living donor liver transplantation(ALDLT),so as to improve the efficacy of ALDLT.Methods The clinical data of 31 adult patients who undelwent ALDLT from June 2006 to February 2008 were retrospectively analyzed.Results Of all the patients,8 was with decompensated cirrhosis,7 with acute liver failure,12 with hepatocellular carcinoma,2 with purpura of liver,1 with hilar cholangiocarcinoma,and 1 with Wilson disease.The liver grafts included 25 right lobes with middle hepatic vein(MHV),3 right lobes without MHV,1 right lobe with MHV+left lateral lobe,1 right lobe with MHV+left lobe.The remaining 1 patient underwent auxiliary partial orthotopic liver transplantation with left lobe graft.Six post-transplantation complications occurred in 5 donors. Eleven post-transplantation complications occurred in 9 recipients,including 4 biliary complications,3 vascular complications,3 infection complications and 1 delayed healing of the incision.After ALDLT,2 recipients died of pulmonary infection and 1 of multiple aspergillus infection. Conclusions ALDLT has become an effective method to expand the source of liver grafts.Rational donor and recipient assessment,surgical procedure and postoperative management are key to ALDLT.

Objective To evalute the accuracy of stroke volume variation (SVV) in monitoring blood volume in patients undergoing off-pump coronary artery bypass grafting.Methods Twenty-one ASA Ⅱ or Ⅲ patients of both sexes aged 44-77 yr undergoing off-pump coronary artery bypass grafting were enrolled in this study.Anesthesia was induced with midazolam,etomidate,fentanyl,rocuronium and dolicaine and maintained with target-controlled infusion of propofol,infusion of remifentanil,intermittent iv injetion of atracurium and inhalation of sevoflurane.The patients were mechanically ventilated (VT 8 ml/kg,RR 12 bpm,I:E 1:2,PEEP 0,FiO2 80％ ).PEr CO2 was maintained at 35-44 mm Hg.Radial artery was cannulated and connected to FloTrac pressure transducer and Vigileo monitor.6％ hydroxyethyl starch 130/0.4 sodium chloride solution 7 ml/kg was infused at a rate of 0.25 ml· kg- 1 1· min- 1 at 5 min of haemodynamics stabilization after pericardiotomy (T1).HR,MAP,CVP,systemic vascular resistance (SVR),systemic vascular nesistance index (SVRI),SVV,stroke volume index (SVI)and CI were recorded at T1 and at 10 min after loading dose (T2).The change rate of HR(△HR),MAP(△MAP),CVP(△CVP),SVR(△SVR),SVV(△SVV),SVI(△SVI) and CI(△CI) were calculated.△SVI≥25％ was considered effective volume expansion.The ROC curves for HR,MAP,CVP,SVR and SVV in determining the volume expansion efficacy were plotted.The area under the curves and 95 ％ confidence interval were calculated.Results Compared with T1,CVP,SVI,CO and CI were significantly increased,SVRI and SVV decreased at T2 (P ＜ 0.01).There was no significant difference in MAP and HR between T1 and T2(P ＞0.05).△SVI was negatively correlated with △HR and △SVR ( r =- 0.737,r =- 0.480,P ＜ 0.05).△SVI was not correlated with △CVP,△MAP and( P ＞ 0.05).The change in SVI was determined by SVV 8.8％ (sensitivity =52.6％,specificity =100.0％ ).The area under the curve for SVV and 95％ confidence interval were 0.579(0.346-0.812).Conclusion SVV can not be used to accuratelymonitor the changes in blood volume in patients undergoing off-pump coronary artery bypass grafting.

Objective:To summarize the perioperative nutrition management,improve the successful rate in liver transplantation patients and reduce the complications after operation.Methods:A retrospective analysis of the perioperative nutrition treatment was made in 71 cases with liver transplantation.The principle of enteral nutrition before operation was appropriate energy,protein and rich vitamin,and the branched-chain amino acid(BCAA) and glutamine(Gln) were supplied.Intravenous nutrition,early enteral nutrition and total enteral nutrition support were applied during the postoperation period.Results: Except 5 cases that died from respiratory failure and 2 died from hemorrhagic shock respectively,other 64 cases recovered gradually in liver function,and their nutrition indices were enhanced significantly.Conclusion:The perioperative nutrition management is very necessary for liver transplantation patients,and the appropriate nutrition support is helpful to rehabilitate the function of graft organ and the nutritional status of the recipients as possible as early.