Objective To investigate the safety and efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection.Methods 62 elderly patients with acute biliary tract infection under conservative therapy were randomly divided into structured triglycerides (ST) group and medium-chain triglycerides plus long-chain triglycerides (MCT/LCT) group.Patients underwent parenteral nutrition for 5 days.Levels of hepatic enzymes,blood triglycerides,nitrogen balance,fasting blood insulin and glucose were compared between the two groups after 5 days of parenteral nutrition.Results There were no significant differences in levels of hepatic enzymes,blood triglycerides and fasting blood glucose between ST group and MCT/LCT group.Plasma total bilirubin (T-Bill) levels were increased in the two groups,and T-Bill level dropped faster in the ST group than in the MCT/LCT group after 7 days of parenteral nutrition(P＜ 0.05).The difference in total cholesterol level dropping was significant between ST group and MCT/ LCT group (P＜0.05).The cumulative nitrogen balance for 5 days had significant difference between ST and MCT/LCT groups [(4.7-±-2.2) g vs.(2.8±0.7) g,P＜0.05].STG group versus MCT/LCT group had less fluctuation of fasting blood insulin level after 1,4 and 7 days of parenteral nutrition.Conclusions In the acute phase of biliary tract infection in elderly patients,ST-based parenteral nutrition can provide energy and help maintain nitrogen balance,with a little fluctuation of fasting blood insulin level.Short-term nutritional support may have better tolerance in the liver and has little effect on the change of hepatic enzymes.

Multilocus sequence typing (MLST) is a molecular genotyping method based on nucleotide sequencing. The procedure of this method characterizes isolates of bacterial species using the DNA sequencing of multiple housekeeping genes(usually seven). For each housekeeping gene, the different sequences present within a bacterial species are assigned as distinct alleles.For each isolate, the alleles at each of the loci define the allelic profile or sequence type (ST). MLST has the advantages of being robust (based on genetic data) and electronically portable to generate data that allow rapid and global comparisons between different laboratories. In this paper, the principle, method, data analysis, application, advantages and flaws of MLST are introduced.

The authors have experinced 8 cases of chronic carbon disulfide poisoning in workers engaged in the viacase rayon industry during the period between March 1987 and September 1988. Cases of carbon disulfide poisoning has not been reported in Korea till then. Carbon disulfide is primarily a neurotoxic poison, therefore those symptoms indicating central and peripheral nervous damage are very important. And it has toxic effects on the various organs such as skin, eye, ear, and respiratory, cardiovascular, gastrointestinal, hepatic, genitourinary, hematological, and endocrine system. Occupational histories were obtained, and clinical findings and laboratory findings were analysed on all cases. 1. Seven (7) cases had been exposed to carbon disulfide for more than 10 years, and 1 case has been exposed for 6 years. 2. Most common symptoms were neurological symptoms such as gait disturbance, extremity weakness, paresthesia, and speech disturbance. 3. Involvement of central nervous system was noted in 7 cases through abnormal findings of electroencephalography, brain computerized tomography, neurological signs, and psychological test. Needle electromyography and nerve conduction study showed polyneuropathy in all cases. Ophthalmological abnormalities were found in 7 cases, mainly retinal microaneurysms and peripheral constriction of the visual field. Renal damage appeared in 4 cases, increase of serum cholesterol and/or triglyceride level appeared in 3 cases, and dercrease of erythrocyte and hemoglobin appeared in 2 cases. And hypertenison appeared in 2 cases, and diabetes appeared in 1 case. One(1) case who has been exposed tn carbon disulfide for 6 years showed polyneuropathy and peripheral constriction of the visual field.
Brain ; Carbon Disulfide* ; Carbon* ; Central Nervous System ; Cholesterol ; Constriction ; Ear ; Electroencephalography ; Electromyography ; Endocrine System ; Erythrocytes ; Extremities ; Gait ; Korea ; Needles ; Neural Conduction ; Paresthesia ; Poisoning* ; Polyneuropathies ; Psychological Tests ; Retinaldehyde ; Skin ; Triglycerides ; Visual Fields

OBJECTIVE To summarize the experience of prevention and treatment of the deep fungal infection after thoracotomy.METHODS To enhance the prevention of the deep fungal infection after thoracotomy.To watch out for the change of postthoracotomy symptom,when doubtful clinical symptom appeared in the susceptible sufferersand to track the result of culture and adopt early experiential antifungal medication to treat.RESULTS Out of 38 patients 33 were cured,5 were died(13.16%).CONCLUSIONS To enhance the prevention of the deep fungal infection after thoracotomy,the early diagnosis and treatment with experiential antifungal medication are the important measures to improve prognosis in the patients with postthoracotomy infection of deep fungi.

Purpose To evaluate the application value of volume CT perfusion (CTP) protocol with 128-slice CT scanner in patients with unilateral middle cerebral artery (MCA) stenosis or occlusion.Materials and Methods Thirty-five patients with severe unilateral MCA stenosis or occlusion who underwent cerebral volume CTP examination in Wuhan No.1 Hospital between July 2013 and December 2014 were evaluated.The volume CTP parameter maps of cerebral blood flow (CBF),cerebral blood volume (CBV),mean transit time (MTT) and time to peak (TTP) were analyzed.Meanwhile,the dynamic CT angiography (4D-CTA) images were obtained.Results In three patients,CBF,CBV and MTT were observed normal but TTP was delayed.In the other thirty-two patients,CBF in the affected side was lower than that in the contralateral side (but difference without significance:P＞0.05).The increased CBV,prolonged TTP and MTT were also detected in the affected side compared with the contralateral side (difference with significance:P＜0.05).McNemar test showed 4D-CTA and DSA diagnosis of middle cerebral artery occlusion were not significantly different (P＞0.05),and they had better consistency (Kappa=0.861,P＜0.05).Conclusion Brain volume CTP protocol with 128-slice CT scanner provides valuable information about cerebral artery abnormalities and hemodynamic changes in patients with severe stenosis or occlusion of MCA.It has great value for clinical application.

ObjectiveTo study the impact of primary PCI in culprit artery on epicardial blood flow of nonculprit artery in patients with STEMI. MethodsEnrolled 117 patients with anterior wall STEMI were treated with primary PCI in the culprit artery, left anterior descending artery (LAD, as study group.Another 100 patients with normal coronary artery evidenced by angiography were enrolled as control group.The differences in CTFC (corrected TIMI frame count measured by using digital subtraction arteriography,TIMI =thrombolysis in myocardial infarction) and MBG (myocardium blood flow perfusion grading)between pre and post primary PCI in both culprit artery and nonculprit artery ( left circumflex artery, LCX),and CTFC and MBG were also detected in the subjects of control group. Blood samples were collected and the levels of CRP (C-reactive protein) were assayed. Clinical and angiographic features were analyzed.ResultsThe CTFC of nonculprit artery (LCX) and the level of MBG in patients with anterior wall STEMI were different from the level of MBG and CTFC in control group ( P＜0. 05) before primary PCI. The level of MBG and CTFC in nonculprit artery (LCX) were improved (P ＜ 0. 05 ) after primary PCI, but they did not resume to normal level. Patients without reflow in culprit artery had higher incidence of no reflow in nonculprit artery than patients with re-flow (78％ vs. 8％, P ＜ 0. 01 ), and the level of CRP in patients without reflow in nonculprit artery were higher than those in patients with re-flow ( P ＜ 0. 05). Conclusions The perfusion of nonculprit artery may be impaired in patients with STEMI. Although the perfusion of nonculprit artery may be improved after primary PCI in culprit artery, but it was still lower than those in the control group, and inflammation mechanism might contribute to it.

Objective To evaluate the expression of endostatin in bronchoalveolar lavage fluid (BALF) and serum in patients with lung cancer, and to analysis the relationship between endostatin expression and clinical prognosis as well as pathophysiological characteristics. Methods The samples of serum and BALF were obtained from 57 patients with untreated primary lung cancer ( lung cancer group) and 27 patients with benign pulmonary diseases (control group). The levels of endostatin were analyzed by enzyme-linked immunosorbent assay (ELISA). Results The expression of endostatin in serum and BALF in lung cancer group was significantly higher than that in control group ( P ＜0. 01 ). The levels of endostatin in serum and BALF in late-stage ( stage Ⅲ or Ⅳ ) lung cancer patients were significantly higher than that in early-stage ( stage Ⅰ or Ⅱ , P ＜ 0. 01 ).The expression of endostatin both in serum and BALF were significantly higher in adenocarcinoma patients than that in squamous cell carcinoma or SCLC patients. Endostatin concentrations in BALF and serum were significantly greater in patients with lymph node and distant metastasis than those patients without. the expressions of endostatin in serum were closely related to that in BALF in patients with lung cancer ( P = 0. 000). Conclusion The expression of endostatin in serum and in BALF is higher in lung cancer than benign pulmonary diseases and it was associated with TNM stage, lymph node metastasis and clinicopatholgical variables. The level of endostatin in BALF is higher than that in serum and may be used as a significant marker to direct clinic therapy and estimation of prognosis.

Objective To observe the perioperative management of cardiac surgery and extracorporeal circulation method in patients with glucose-6-phosphate dehydrogenase deficiency(G6PD).Methods Ten patients with G6PD deficiency underwent uneventful cardiac surgery procedures between January 2005 and December 2010.Twenty patients who had non-G6PD deficiency were as a control group,the selected conditions were the same gender,age,body mass,the risk of heart disease surgery.The preoperative management in patients with G6PD deficiency mainly focused on avoiding the drugs implicated in haemolysis,reducing the surgical stress,using moderate hypothermia extracorporeal circulation and enhancing blood conservation.Observed indicators included the assisted ventilation time,urine volume,the drainage volume of chest tube,the amount transfusion of red blood cells and plasma,the level of hemoglobin and serum total bilirubin in the 2nd day after surgery,ICU stay.Results Compared with the control group,patients with G6PD deficiency had no significant difference in duration of ventilation after the operation,drainage,urine,Hgb,bilirubin levels,and blood transfusion[(9.3 ± 4.5)h vs (8.6 ± 5.7)h,(2100 ±670)ml vs (1950 ± 490) ml,(253 ± 146)ml vs (260 ± 120)ml,(1.3 ± 1.0)U vs (1.8 ± 1.2)U,(96 ± 25)g/L vs (99 ± 12)g/L,and (24 ± 8)μmol/L vs (27 ± 1 l)μmol/L,t =0.978,2.032,1.257,0.891,2.182,2.271,and 1.329,all P ＞ 0.05].The duration of ICU discharge was significantly longer in the glucose-6-phosphate dehydrogenase deficient group[ (2.6 ± 0.6)d vs (1.8 ± 1.5)d,t =2.704,P ＜ 0.05].Conclusions Cardiac surgery can be performed safely in patients with G6PD deficiency with enhanced perioperative management.

Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

Objective To evaluate the changes in sagittal profiles and complications during treatment with growing rods (GRs) in hyperkyphotic early-onset scoliosis (EOS).Methods From December 2009 to December 2016,a total of 32 EOS patients who received growing rods treatment in our center,including 8 males and 24 females,were reviewed retrospectively.All the patients had minimum 2-year follow-up and over 2 lengthenings.Based on the reference value of thoracic kyphosis (TK) in T2-12 of normal children,the patients were categorized into an N group (20°≤TK≤50°,15 cases,4 males and 11 females) or K group (TK≥50°,17 cases,4 males and 13 females).The distribution of etiology was similar between the two groups.The average age was (6.2±2.0) years and (6.3±2.3) years respectively,curve flexibility was 34.6％± 10.4％ and 35.8％± 11.2％ before surgery.The precontoured rods were tunneled submuscularly,connecting proximal and distal anchors,and tandem or domino connectors.The rods were then locked after applying direct distraction that allowed appropriate elongation.The connectors were all placed under the deep fascia.Results The mean follow-up in the N and K groups was (5.5±1.9) years and (5.5±2.1) years,respectively.The distribution of proximal and distal anchors was similar between the two groups.The N and K groups,respectively,had an average number of lengthenings of 5.1±2.0 and 5.3±2.3,with mean lengthening intervals of (11.3±2.3) months and (10.9±1.9) months,respectively.In the N group,TK was decreased from 36.0°±9.4° to 30.6°±.8.3° after surgery,and to 32.2°±7.8° at the last follow-up,demonstrating it was maintained within the normal range.In the K group,TK was markedly reduced from 67.6°±11.6° to 41.7°±8.7° after the index surgery,with a correction rate of 38.3％± 14.6％,and the difference was statistically significant.And then it slightly increased to 46.5°±8.4° at the last follow-up,with correction loss of 7.1％±4.2％,and the difference was not statistically significant compared with the postoperatiom.The complication rate in the K group was significantly higher than in the N group (76.5％ vs.33.3％,P=0.031).The most common implant-and alignment-related complication in both groups was rod fracture (15.6％) and proximal junctional kyphosis (21.9％),respectively.The incidence of rod fracture in the N group and K group was 6.7％ and 23.5％,respectively.And the incidence of proximal junctional kyphosis was noted as 13.3％ and 29.4％ in the N group and K group,respectively.Proximal junctional angle (PJA) in the K group was greater than that in the N group preoperatively,postoperatively and at the last follow-up.Moreover,the increasing amount of PJA was significantly greater in the K group compared to the N group (1.6°± 1.0° vs.0.7°±0.8°).Four and seven complication events in the N and K groups,respectively,were evaluated with Grade Ⅰ.Four and seven complication events in the N and K groups,respectively,were classified as Grade Ⅱ A.Conclusion GRs can effectively restore the sagittal profile in hyperkyphotie EOS patients,but with a higher complication rate compared to the patients with normal kyphosis.