Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in radical resection of hepatocellular carcinoma (HCC).Methods The propensity score matching (PSM) and retrospective cohort study were conducted.The clinicopathological data of 116 patients with HCC who were admitted to the Fuzhou General Hospital of Nanjing Command of PLA from June 2014 to January 2016 were collected.Fifty-eight patients using pre-,intra-and post-operative ERAS managements were allocated into the ERAS group and 58 using traditional perioperative managements were allocated into the control group.Observation indicators:(1) operation situations;(2) postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of alanine transaminase (ALT),total bilirubin (TBil),C-reactive protein (CRP) at 1,3 and 7 days postoperatively,postoperative complications (vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection),duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients;(3) follow-up situation.Followup using outpatient examination and telephone interview was performed to detect survival of patients up to March 2016.Measurement data with normal distribution were described as x±s.The comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).The comparison between groups was analyzed using the paried rank sum test.Repeated measurement data were evaluated by the repeated measures ANOVA.Results (1) Operation situations:all the patients underwent successful operations,without perioperative death.(2) Postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of ALT,TBil and CRP at 1,3 and 7 days postoperatively,duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients were (49±10)hours,(60±10)hours,(3.3±0.7)days,(379±99)U/L,(222±65)U/L,(98±16)U/L,(20.4±4.7)μmol/L,(15.5±2.1)μmol/L,(13.4±1.8)μmol/L,(49±10)mg/L,(124±21)mg/L,(30± 5)mg/L,(9.7±0.9)days,(4.1±0.6) ×104 yuan,8.6±0.9 in the ERAS group and (53±5)hours,(64±7)hours,(6.2±1.6)days,(445± 114)U/L,(278±79) U/L,(116± 25) U/L,(18.6± 3.5) μmol/L,(17.0±2.7) μmol/L,(14.2±1.9)μmol/L,(53±11)mg/L,(135±35)mg/L,(34±6)mg/L,(10.0± 1.0) days,(4.3±0.5)x104 yuan,8.2±1.0 in the control group,respectively,with statistically significant differences between the 2 groups (t=2.537,2.479,2.065,F=20.075,14.357,13.460,t=2.060,2.197,2.370,P＜0.05).Number of patients with postoperative vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection were 5,3,2,1,1 in the ERAS group and 6,6,7,5,3 in the control group,respectively,with no statistically significant difference between the 2 groups (x2=0.100,1.084,3.011,0.206,0.618,P＞ 0.05).(3) Follow-up situation:all the 116 patients were followed up for 1-20 months,with a median time of 11 months.During the follow-up,2 patients in the ERAS group died (1 dying of tumor recurrence and 1 dying of respiratory failure) and 3 in the control group died (1 dying of multiple organs metastasis,1 dying of lung metastasis of HCC and 1 dying of myocardial infarction).Conclusion ERAS in the perioperative management after radical resection of HCC is safe and effective,and it can quickly improve postoperative recovery of patients.

[Objective]To measure the change of anatomic configuration of proximal tibial after high tibial osteotomy and probe its clinical consequences.[Method]From 2001 to 2005,there were 59 knees of 35 patients with medial unicompartmental osteoarthritis treated with closing-wedge high tibial osteotomy.Anatomic configuration of proximal tibia were measured both pre and postoperatively on radiographs.They included posterior slope angle of proximal tibia,tibial angle,lateral shift of articular surface of proximal tibial and level of the joint line.The alteration of the above features was calculated and analyzed statistically with paired t test.[Result]The mean tibial posterior slope angle were(8.9??2.6?)preoperatively and(5.0??2.3?)postoperatively.The tibial posterior slope angle was averagely decreased about(3.9??1.7?).Tibial angle were(99.1??4.3?)and(91.1??3.8?)before and after high tibial osteotomy respectively.Lateral shift of articular surface of proximal tibial were(46.2?3.6)% and(53.1?3.9)% in pre and postopratively.Level of joint line was(41.2?3.6)mm and(38.0?3.2)mm in pre and postopratively.Statistical analysis indicated that there was significant difference of posterior slope angle or tibial angle or lateral shift of articular surface of proximal tibial or level of joint line between pre and post operative(P

Objective: To develop a resiliency scale for university students. Methods: Based on reference research and some similar foreign scales, the resiliency scale for university students, including 6 factors and 31 items, has been developed and its reliabilities and validities has been studied. Results: The ? coefficients of the total and 6 subscales was 0.6383-0.8594; the split-half reliability of the the total and 6 subscales was 0.6334-0.8600. A good construct validity was found by some indexes(?2/df=2.27,RMSEA=0.048,GFI=0.8991,IFI=0.9006) demonstrated by confirmatory factor analysis. The scores of this scale had significant correlations with SCL-90 scale. Conclusion: A good psychometric feature of the scale has been demonstrated.

Objective: To investigate the impact of severity of coronary lesion on left ventricular end diastolic pressure(LVEDP) in patients with coronary artery disease(CAD). Methods: 683 cases of consecutive coronary angiography were adopted for study according to the criteria and grouped in terms of extent and severity of coronary lesion and AHA coronary arterial lesion score respectively. The LVEDP were measured ventriculographically. Results: Comparing with the accordant contrast group, LVEDP was slightly decreased without statistical significance in the single vessel group in the (25%-50%) stenosis group, and the (1-3) scores group; while slightly increased without statistical significance in the double vessel group in (26%-50%) and (51%-75%) stenosis groups and (4-6) scores and (7-9) scores groups. There was a significant increase in the triple vessel group, in the 100% stenosis group, and the ≥10 scores group(P

Objective To study the risk factors and left ventricular function in acute myocardial infarction (AMI) patients without angiographically coronary artery stenosis, and elucidate the possible mechanisms. Methods 399 AMI patients of selective coronary angiography were divided into two groups in terms of severity of coronary lesion: the group without angiographically coronary artery stenosis (coronary artery diameter stenosis percentage less than 50%) and the group with angiographically coronary stenosis (coronary artery diameter stenosis percentage equal to or more than 50%). The risk factors and left ventricular function were compared between the two groups. Results 5.76% (23/399) cases showed no angiographically coronary artery stenosis, while 94.24% (376/399) cases showed angiographically coronary artery stenosis. Compared with the group with coronary stenosis, the group without angiographically coronary artery stenosis featured more in young people aged less than 40 (26.08% vs 6.12%, P0.05). Left ventricular end diastolic pressure (LVEDP) was lower in the group without angiographically coronary artery stenosis (12.53 mm?Hg?5.46 mm?Hg vs 18.75 mm?Hg?7.10 mm?Hg, P0.05). Conclusion AMI without angiographically coronary artery stenosis is not a rare phenomenon, to which attention should be paid. The group without angiographically coronary artery stenosis features a better left ventricular function, and its prevalence is higher in young patients and female. Both group share the same risk factors such as diabetes, hyparlipedemia and hypertension.

OBJECTIVETo investigate the impact of hyperglycemia on the hydrogen sulfide (H2S) signaling pathway in rat penile tissue and its relationship with erectile function.

METHODSTwenty healthy male Sprague Dawley (SD) rats aged 8 weeks were randomly divided into groups A (4-week healthy control), B (4-week diabetes mellitus model), C (6-week healthy control) and D (6-week diabetes mellitus model). The rats in groups B and D were injected intraperitoneally with streptozotocin at 50 mg/kg to induce diabetes mellitus, while those in groups A and C with the same volume of normal saline. The animals were killed at 4 (groups A and B) and 6 weeks (groups C and D) after treatment for measurement of the maximal intracavernous pressure/mean arterial blood pressure (ICP(max)/MAP) by electrostimulation, determination of the H2S concentration in the plasma and penile tissue, and detection of the expressions of cystathionine-beta-synthetase (CBS) and cystathionine-gamma-lyase (CSE) in the penile corpus cavernosum by immunohisto- chemistry and Western blot.

RESULTSWith electrostimulation of the pelvic ganglia at 5V and 7 V, ICP(max)/MAP was significantly reduced in groups B (0.19 +/- 0.03 and 0.29 +/- 0.04) and D (0.14 +/- 0.04 and 0.25 +/- 0.04) as compared with A (0.46 +/- 0.07 and 0.68 +/- 0.09) and C (0.43 +/- 0.07 and 0.65 +/- 0.16) (P < 0.05). No statistically significant differences were found in the level of serum testosterone either between groups A and B ([469.19 +/- 126.46] ng/dl vs [359.08 +/- 60.06] ng/dl, P > 0.05) or between C and D ([470.44 +/- 209.28] ng/dl vs [297.01 +/- 96.58] ng/dl, P > 0.05). Groups B and D showed remarkable reduction in the H2S concentration (P < 0.05) and the expressions of CBS and CSE (P < 0.05) in comparison with A and C, and the CBS and CSE expressions were even more significantly decreased in D than in B (P < 0.05).

CONCLUSIONThe reduced concentration of H2S and decreased expressions of CBS and CSE in the penile corpus cavernosum of the diabetic rats suggested that the H2S signaling pathway might be involved in hyperglycemia-induced erectile dysfunction.

Animals ; Blood Pressure ; physiology ; Cystathionine gamma-Lyase ; metabolism ; Diabetes Mellitus, Experimental ; chemically induced ; metabolism ; Electric Stimulation ; methods ; Erectile Dysfunction ; etiology ; Humans ; Hydrogen Sulfide ; metabolism ; Hyperglycemia ; metabolism ; Lyases ; metabolism ; Male ; Penis ; enzymology ; physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Testosterone ; metabolism

Objective To study the diagnostic value of fractional exhaled nitric oxide(FeNO)in non-typical bronchial asthma.Methods Ninety-five patients with unknown-cause respiratory symptoms including wheezing,cough and breathlessness were enrolled.FeNO was measured by nitric oxide analyzer.The clinical symptoms and bronchial bronchodilator test were defined as golden standard for asthma diagnosis.The diagnostic value of FeNO was assessed and the optimal operating point of FeNO test was determined by means of the receiver operating characteristic(ROC)curve.Results Among 95 patients,44 cases were diagnosed as asthma,51 cases were diagnosed as non-asthma.The level of FeNO of asthma patients were higher than that of non-asthma patients[(55.2±14.0)nmol/L vs.(18.9±5.2)nmol/L,P＜0.01].A non-linear correlation of FeNO with FEV1％ was revealed in the cases with asthma(r=-0.162,P＞0.05).Area under ROC curve was 0.858.The optimal diagnostic cut off point was 36 nmol/L which was capable of differentiating asthma and non-asthma with sensitivity of 80.2％,specificity of 79.5％,positive predictive value of 85.4％,negative predictive value of 83.3％ and accuracy of 85.9％.Conclusions FeNO test may be helpful in the diagnosis of non-typical asthma with high sensitivity and specificity,which can also improve the diagnostic effectiveness and avoid misdiagnosis,missed diagnosis when combined with lung function test.

Image processing research group applied immersive experience into “medical image processing”. A scheme named “introduction by game, case driven, lecture on specific theme, grouping experiment, and seminar”was designed and practiced. We designed a game for each subject and made students immersed in the game to feel the pleasure of learning. We changed the traditional teaching method which focused on every point of knowledge, presented and then decomposed the case before teaching each knowledge point which was related to the case. By grouping experiment and seminar, students can learn actively. We also developed a virtual experiment platform with .NET and Matlab for students to develop learning.

Objective To investigate the efficacy and safety of the minimally invasive percutaneous surgery in the treatment of thoracolumbar fracture combined with posterior ligament injury.Methods The 94 cases of thoracolumbar fracture combined with posterior ligament injury who were admitted into our hospital from Septenber 2012 to January 2016 were selected and equally divided into the observation group and the control group(47 cases in each group) according to different methods.Patients of the observation group were treated with short segment of minimally invasive percutaneous surgery,while patients of the control group were underwent single segment of minimally invasive percutaneous surgery.Recorded the outcomes and prognosis of the two groups.Results There was no significant difference in the operation time and blood loss between the two groups(P ＞ 0.05).The postoperative volume of drainage and the length of stay in the observation group were significantly shorter than those in the control group(P ＜ 0.05).The JOA score of the observation group 1 month after operation was significantly better than that of the control group(P ＜ 0.05).The incidence of complications including pedicle screw breakage,pedicle screw loosening,incision infection,and pulmonary infection in the observation group was 4.3％,which was significantly less than 21.3％ in control group (P ＜ 0.05).The Cobb's angle of the obervation group and control group 1 month after operation were (8.55 ± 1.34) ° and (16.30 ± 2.33) ° respectively,which were significantly lower than (32.19 ± 1.98) ° and (32.08 ± 2.08) ° before operation (P ＜ 0.05).And the Cobb's angle 1 month after operation in the observation group were significantly lower than that of the control group(P ＜ 0.05).Conclusion The short segment of minimally invasive percutaneous surgery for the treatment of thoracolumbar fracture combined with posterior ligament injury can reduce the incidence of postoperative complications,promote the patient's rehabilitation,correct the kyphosis and promote the recovery of neural function,which was safer and more efficient.

Objective To evaluate the surgical technique of titanium miniplates in reconstruction of laminar roof after a posterior approach in intraspinal tumor surgery. Methods From August, 2007 to March, 2009, 11patients underwent intraspinal tumor surgery with osteotomy and reconstruction of laminar roof, titanium miniplates were used for fixing in the re-implantation. There were 2 intramedullary tumors,9 extramedullary tumors. The target of surgery was the cervical spine in 2 cases, the cervicothoracic spine in 4 cases, the thoracic spine in 2 cases, the thoracolumbar spine in 2 cases, and the lumbar spine in 1 cases. The patitens were followed up for 6 months to 2years. Local pain,bony healing and spinal malformation were assessed. Results In the 11 patients, there was no case of dural, nerve root, or spinal cord injury due to laminar roof reconstruction. One patient complained of moderate to severe local pain during follow-up and 2 patients complained of occasional slight pain at the surgical site. No limitation of activity occurred. Bony healing was confirmed radiologically or CT scan in 9 patients. There were no patients demonstrated a new spinal malalignment, and no patients developed stenosis of the spinal canal. Conclusions The reconstruction of the laminar roof using titanium miniplates will benefit the recovery of normal structure of spine,and maintain the stability of spine,and avoid the occurrence of stenosis of the spinal canal.