Acupuncture Therapy ; Adult ; Aged ; Anesthetics ; administration & dosage ; Combined Modality Therapy ; Female ; Humans ; Intervertebral Disc Displacement ; drug therapy ; physiopathology ; therapy ; Male ; Middle Aged ; Nerve Block ; Spinal Nerve Roots ; drug effects ; physiopathology

Time to positivity(TTP) is a new parameter in blood culture field.The article shows us the concepts of TTP,differential time to positivity (DTTP),and introduces their relation with bloodstream infection (BSI),catheter-related bloodstream infection (CRBSI).Besides,it stresses TTP' s clinical application,including determining the severity of disease;identifying the isolates whether pollution or not; identification of isolate strains ; detection of the drug resistance of isolates ; evaluating the effect of antibiotic ; helping to adjust the therapeutic drug; diagnosing or excluding CRBSI by means of DTTP;deciding whether the catheter is the source of infection in patients with candidemia; understanding the epidemiological distribution of strain.At the same time,the article also describes the shortcomings and domestic current status.

Objective To study the diagnosis and radical resection of hilar cholangiocarcinoma. Methods Retrospective analysis was made on the clinical feature and the effect of radical resection on 38 cases of hilar cholangiocarcinomas.Results Diagnosis was made in all of the patients preoperatively.The radical resection was perfomed on 38 patients.Of them, 3(7.9%) died after operation.After operation, 5 cases (13.2%) developed bile leakage,and 2 of the 5 cases developed subphrenic abscess,which were cured by drainage; 4(10.5%) had right hydrothorax that was cured by conservative therapy; and 3(7.9%)had incision split that was cured by resuture. Among the 35 postoperative survivors,34 (97.1%) were followed up, the 1- and 3-year survival rates were 91.9% and 35.2%.None of the patients survived for 5 years. Conclusions It′s still difficult to make early diagnosis in hilar cholangiocarcinoma.The diagnosis mainly depends on the combination of imaging examinations. Nowadays the radical resection rate of hilar cholangiocarunoma is still low, the recurrence and metastasis are common after operation, and few patients can survive for a long time. It suggests that even in radical operation for hilar cholangiocarcinoma, the regions of resection and sweep are not enough,and the operative procedure needs to improve further.

Objective To explore the MR imaging of reverse and separation of meniscal articular capsule.Methods MR imaging of reverse and separation of meniscus articular capsule confirmed by surgery and arthroscope were analyzed retrospectively in 8 cases.Results The “Butterfly knot sign” disappeared and was replaced with fluid signal on the sagittal slice of meniscal body in 8 cases. Part of back angle remained in 3 cases. “Double anterior cruciate ligament sign” was showed on one side of middle sagittal slice in 7 cases. “Reverse meniscus sign” was revealed in intercondylar fossa on the coronary view in ~8 cases. Abnormal high signal was showed in the injured meniscus in 6 cases. Abnormal high signal was detected in the opposite meniscus in 5 cases.Conclusion The MR findings of reverse and separation of meniscus articular capsule include disappearance of “butterfly knot sign”, appearance of “reverse meniscus sign” and “double anterior cruciate ligament sign”. The diagnosis would be established if the former 2 signs were present or all the 3 signs were present simultaneously.

Objective To investigate the approaches for diagnosis and treatment of intrahepatic cholangiocarcinoma(ICC)and asgess its prognosis factors.Methods The clinical data of 86 patients with ICC in our hospital from January 1995 to December2005 were retrospeetively analyzed.All patients were divided into two groups according to the treatment method,including hepatectomy and lymphatic clearance group(Group A,n=42)and hepateetomy group(Group B,n=44),and their clinicopathological variables were analyzed.Resuits The 1-,3-and 5-year survival rates were 77.81%and 35.21%,20.93%and 19.82%,2.31%and 0%respectively between group A and group B.There was significantly difference between these two groups(P＜0.01).The analysis showed that resection and lymphatic clearance were correlated to prognosis.The 1-,3-and 5-year survival rates were 59.21%,26.21%,and 20.11% respectively in 47 patients who were found no lymph node metastasis,and the 1-,3-and 5-year survival rates were 19.82%,2.31%and 0% respectively in 39 patients who were found lymph node metastasis.There was significantly difference in survival rate between group A and group B(P＜0.01).Condusions Reseetability and lymphatic clearance are two significant factors correlated to survival of the patients with ICC.Aggresgive treatment of lymph node metastasis in hepatoduodenal ligament is an important strategy to improve survival rates and strengthen patient's life quality.

Objective To report the clinical outcomes of applying endoscopic incision in the treatment of ureterovesical anastomosis site obstruction in transplanted kidneys. Methods Between February 2001 and April 2008, 13 men and 5 women with ureterovesical anastomotic site obstruction in their transplanted kidneys were treated by endoscopic incision with electrocautery or holmium: YAG laser. After the anastomosis was completely resected, two Double-J stents were placed in the ureter for 6-8 weeks. During follow-up, renal function, ultrasound examination and wash-out renal scintig-raphy were performed every month for the first 6 months, then every 3 months. Results Total 25 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. No complication was recorded during or after the procedure. At the mean follow-up of 51 months (range 4-90 months), 5 patients presented with recurred obstructive uropathy immediately after the Double-J stent removal and finally underwent open surgical correction. Conclusions Endo-scopic incision is safe and effective in the treatment of ureterovesical anastomosis site obstruction in transplanted kidney. However, open surgical reconstruction should be considered if endoscopic inci-sion procedure has failed.

Objective To establish a rat model of middle cerebral artery occlusion (MCAO)by blockage or obstruction of middle cerebral artery. NO precursor L-Arginine (L-ARG) and NO donator Nitroglycerine (NG)are administrated from intraearotid arteries. DWI and PWI are applied to evaluate blood circulation and brain damage of the effected region to elucidate the piotective function of L-ARG and NG in the early stage of brain ischemia. Methods The middle cerebral artery was occluded by insertion of a suture through the internal carotid artery of SD male rats to duplicate ischemia-reperfusion model. Reperfusion was established by suture withdrawal. After 2 hours of blockage, reperfusion and administrate L-ARG,NG by interventional therapy through the internal carotid artery simultaneously. Image indexes such as T1WI, T2WI, DWI and PWI are utilized to assess the changes in different time points. These indexes, Longa score and TTC stain were compared. Results There were obvious decrease in DWI high signal region and Trc pale region in drugs groups, compared with MCAO group(P＜0.01).ADC and rADC values in DWI high signal region increased gradually from 2 hours after ischemia to 24 hours after reperfusion in each group. ADC and rADC values in DWI high signal region of the drugs groups increased obviously(P＜0.01).Conclusion Interventional therapy with NO precursor/donator showed significant protective function in the early stage of brain ischemia.

Objective To summarize our preliminary experience of selective fetieide with bipolar coagulation in complicated monochorionie twins(MCT),and discuss the clinical application of feticide in discordant MCT.Methods Three MCT with one twin anomaly.in which 2 had severe twin-twin transfusion syndrome(TTTS),stage Ⅳ ,and 1 had acardiac twin,were identified in the second trimester of pregnancy.To terminate the abnormal twin and isolate the co-twin's circulation completely.selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy.After each invasive procedure,serial monitoring was performed,including procedural complications,Doppler of fetal middle cerebral artery and umbilical artery.Pregnancies were followed up every 2 weeks for fetal growth until delivery.After birth the placentas and the terminated fetuses were examined.Result Cord occlusion was successfully accomplished in all 3 targeted fetuses,at 21,22 and 24 weeks of gestation respectively.One case with TTTS was complicated with rupture of the membrane in the terminated fetus at the 7th day after the procedure.and a healthy baby was born at 32 weeks.The other case with TTTS delivered a boy by cesarean section at 38 weeks.The third case with TRAP is at 35 weeks of gestations and under regular follow-up.Monochorionicity was confirmed by placental examination after delivery.and the effects of bipolar coagulation were observed at the,cord of terminated fetuses.Conclusions Umbilical cord occlusion witll bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly.The outcome of normal fetus can be favorable.

Objective To investigate the efficacy of sequential ERCP and laparoscopy for acute biliary pancreatitis (ABP).Methods A total of 80 patients with ABP were randomly divided into 2 groups to receive sequential ERCP and laparoscopy (observation group,n=40) or traditional surgery (control group,n=40).Clinical data including abdominal pain relief time,recovery time of white blood cell,blood amylase and liver function,hospital stay,complication rate and mortality were analyzed.Results ERCP failed in 1 patient in observation group,and the remaining 39 patients (97.5％) were recruited into the study.There were significant differences between 2 groups in regarding of abdominal pain relief time (7.7±2.7 d vs.11.4±3.7 d),recovery time of white blood cell ( 9.7±2.6 d vs.13.3±3.9 d ),blood amylase ( 8.2±2.1 d vs.12.5±3.3 d ),liver function ( 12.5±5.1 d vs.21.3±6.5 d ),hospital stay ( 16.1±5.1 d vs.23.3±7.6 d ) and rate of complication ( 12.8％ vs.30.0％ ).There was no significant difference in morbidity between 2 groups (5.1％ vs.7.5％).Conclusion Sequential ERCP and laparoscopy is effective for ABP.

Objective To analyze the clinical characteristics of twin reversed arterial perfusion sequence (TRAP),and investigate its prenatal evaluation and clinical management.Methods Karyotype results and ultrasound data of 25 TRAP cases were retrospectively reviewed,including estimated weight and umbilical blood flow of acardiac twin,cardiac function and middle cerebral artery peak systolic velocity of pump twin.Various managements and the outcomes were analyzed.Results (1) Karyotype of amniotie fluid were tested in 16 pump twins.Mosaicism was found in 1 case (46,XX[36]/46,XY [14]).(2) According to the ultrasound evaluation,large acardia accounted for 87.0％ (20/23) cases.Abundant blood perfusion (inter-twin difference of umbilical resistance index ≤0.20) was indicated in 86.4％ (19/22) cases.Decompensation of cardiac function was suggested in 66.7％ (10/15) pump twins.Fetal anemia of pump twin indicated by middle cerebral artery peak systolic velocity＞1.5 multiples of the median was diagnosed in 75.0％ (12/16) cases.(3) The acardiac twin with abundant blood perfusion was more likely to be a large acardia than those without [94.7％(18/19) vs 1/3,Fisher exact test,P=0.04]; More pump twin with large acardia tended to have cardiac decompensation than non-large acardia pump twins [83.3 ％ (10/12) vs 0/3,Fisher exact test,P=0.02].(4) Eleven patients chose to terminate their pregnancies after being diagnosed.In 14 cases who continue the pregnancies,the survival rate of pump twin was 64.3％ (9/14).In 3 cases of non-large acardia without cardiac decompensation of pump twin,the patients selected conservative observation resulting in 2 term deliveries and 1 termination of pregnancy due to for exacerbation.Among 11 cases with large acardia,which the pump twins were complicated by cardiac decompensation or anemia,five cases selected conservative observation.One ended in spontaneous abortion; three exacerbated (one termination and two cesarean section before term with living births) ; one was stable until delivery.Another 6 cases received bipolar cord coagulation,and successful interruptions of acardiac blood flow were achieved in 5 cases among which 4 pump twins survived.Conclusions Prenatal diagnosis,cardiac function and fetal anemia of pump twin,together with the growth and blood supply of acardia are important indexes for prenatal evaluation of TRAP,on which our prompt management should be based.