Alloys ; adverse effects ; Cobalt ; adverse effects ; Dust ; Humans ; Occupational Exposure ; adverse effects ; Tungsten ; adverse effects

Objective Face-down positioning after vitrectomy and gas tamponade is still the standard position for patients with rhegmatogenous retinal detachment.The study was to compare the nursing effects of face-down position and flexible position after vitrecto-my for the repair of rhegmatogenous retinal detachment. Methods We investigated 120 cases of patients with rhegmatogenous retinal detachment in this study.All patients received vitrectomy with long-acting gas for tamponade, 60 patients in face-down position and 60 in the flexible position.Patients were followed up for 6 months.Observation was made on the rates of anatomical retinal reattachment and postoperative complications between the groups. Results The rates of anatomical retinal reattachment after surgery were 88.33%in the face-down position group and 100% in the flexible position group respectively.As to the satisfaction of position, the flexible position group was 100%, which was much higher than 41.67%in face-down position group(P<0.01). Conclusion Flexible position nurs-ing after vitrectomy and gas tamponade for rhegmatogenous retinal detachment repair is safe and effective.Flexible position can replace face-down position for the comfort of patients with rhegmatogenous retinal detachment after vitrectomy with gas tamponade.

Objective To evaluate the methods and efficacy of retroperitoneal laparoscopic nephron-sparing surgery for the treatment of renal tumor. Methods A total of 6 patients with renal tumors underwent retroperitoueal laparoscopie nephron-sparing surgery during warm ischacmia. Among the 6 eases, 2 had malignant tumor with the diameter of 2.5 cm and 2.2 cm,and 4 had renal angiomyolipoma with the diameter from 2.5 cm to 3.5 cm.The renal yes,Is were secured by a self-made equipment. Tumors were excised with a cold Endo-shear. Parenehymal edges were approximated using a absorbable hemostatic gauze. Results All procedures were successfully completed without open conversion. Mean surgical time was 150 minutes (range 120-210 minutes). Mean ischaemia time was 22 minutes (range 18-33 minutes) and the mean blood loss was 170 ml (range 150-200 ml). Surgical margins were negative in all patients.During a follow-up for 6-12 months, no patient had local or port site recurrence. Conclusions Betroperitoneal laparoscopic nephron-sparing surgery for renal tumor by using serf-made equipment is safe and effective. This procedure has the advantages of minimal invasion, less blood loss, good vision, and rapid convalescence and so on.

ObjectiveTo explore changes of serum adiponectin and insulin resistance in patients with endometrial cancer and to evaluate the clinical significance and correlation.MethodsThe serum levels ofadiponectinandfastinginsulinweredeterminedbyELISA, electro-chemilluminometryand radioimmunoassay in 35 patients with endometrial cancer [ all patients divided into two groups,A1 group belonged to without postmenopausal when first visiting (n =20),A2 group belonged to postmenopausal when first visiting (n ＝ 15 ) ] and 30 cases of health control.The result of homeostasis nodel assessment-insulin resistance (HOMA-IR) index was calculated.ResultsThe levels of adiponectin in A1 group was lower than that ofhealth control group [(6.7±1.1) versus (10.0 ±1.4) ng/L,P＜0.05],and HOMA-IR was higher than that of health control group ( 3.5 ± 1.8 versus 1.1 ± 0.7,P ＜ 0.05 ).While there were not significant difference between A2 group and health control group (P ＞ 0.05 ).Adiponectin and insulin resistance was negatively correlated ( r =- 0.389,P ＜ 0.05 ).Conclusion Adiponectin reducing and insulin resistance in reproductive age patients may be the independent factors to promote endometrial cancers.

Objective To investigate the antibiotic resistance of extended-spectrum-β-1actamases (ESBLs)-producing Escherichia coli (E.coli) and Klebsiella pneumoniae (K.pneumoniae) isolates and the risk factors of bloodstream infections caused by these strains.Methods Clinical data of 131 patients with E.coli or K.pneumoniae-induced bloodstream infections admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University during September 2009 and June 2014 were retrospectively analyzed.Species identification and antimicrobial susceptibility test were performed by Vitek 2 system,and ESBLs production was tested by standard disk diffusion method.Logistic regression analysis was performed to identify the risk factors of bloodstream infections induced by ESBLs-producing strains.Results Among 131 patients,65 were infected with ESBLs-producing strains,and 66 were infected with non-ESBLs-producing strains.The resistance rates of ESBLs-producing strains were above 50％ for penicillin,aztreonam and third/fourth generation cephalosporins,which were significantly higher than those of non-ESBLs producing strains.The resistance rates of ESBLs-producing E.coli and K.pneumoniae to carbapenems and piperacillin/tazobactam were 0-2.0％,2.3％ and 0-14.3％,26.7％,respectively.The univariate analysis revealed that patients with exposure to cephalosporins in recent 3 months (x2 =18.322,P ＜ 0.01),prior infection with ESBLs-producing strains (x2=14.610,P＜0.01),indwelling catheter in recent 3 months (x2 =13.016,P ＜ 0.01),history of hospitalization in recent 3 months (x2 =11.269,P ＜ 0.01),exposure to quinolones in recent 3 months (x2 =10.638,P ＜ 0.01),nosocomial infection (x2 =8.205,P ＜ 0.01),history of indwelling deep venous catheter or percutaneous central catheter in recent 3 months (x2 =4.817,P ＜ 0.05) and exposure to glucocorticoid hormone in recent 3 months (x2 =4.265,P ＜ 0.05) were associated with infection of ESBLs-producing strains.Multivariate Logistic regression analysis revealed that exposure to quinolones in recent 3 months (OR =6.851,P ＜ 0.01),prior infection with ESBLs-producing strains (OR =6.344,P ＜ 0.01),exposure to cephalosporins in recent 3 months (OR =3.719,P ＜ 0.01),and indwelling catheter in recent 3 months (OR =3.180,P ＜ 0.05) were independent risk factors for ESBLs-producing E.coli or K.pneumoniae infection.Conclusions ESBLs-producing E.coli or K.pneumoniae isolates are highly resistant to most antibiotics,and multidrug-resistance is common.Carbapenems were still the most effective antibiotics against ESBLs-producing E.coli or K.pneumoniae infection.Rational use of cephalosporins and quinolones,strictly following aseptic technique in operation,strict use of indications for indwelling catheterization,and completely eradicating ESBLs-producing strains in previous infections may be helpful in reducing bloodstream infections by ESBLs-producing E.coli or K.pneumoniae.

Tumor cell plasticity, including epithelial to mesenchymal transition (EMT) and its reverse program, mesenchymal to epithe-lial transition (MET), regulates circulating tumor cells and carcinoma metastasis. Twist is overexpressed in rhabdomyosarcoma, breast cancer, gastric cancer, and other tumors. Twist, as a transcriptional factor, cross-talks with multiple signaling pathways, forming a com-plex network to participate in the regulation of EMT/MET in circulating tumor cells, which in turn promotes metastasis of tumor cells. Therefore, monitoring the level of Twist and epithelial–mesenchymal phenotypic molecules is important as it may be beneficial for in-creasing the detection ratio of circulating tumor cells as tumor biomarkers and for evaluating the effects of anticancer drugs.

Objectives To investigate the pathophysiologic mechanisms and the clinical character- istics and variations of nutcracker esophagus(NE).Methods Clinical data obtained from 22 patients with NE were retrospectively analyzed.Seven followed-up patients had esophageal motility,multi-channel electrogastrography(MEGG),the autonomic nervous system(ANS) and psychology tests and were com- pared to 10 healthy subjects(HS).Results①In NE group,12 patients had reflux symptom(55%),7 patients had chest pain(32%)and 3 patients had dysphagia(13%).There was no statistical difference in mean contraction amplitude(MCA) between patients with reflux symptom and chest pain.②Eight out of the 13 patients with NE who received 24 h pH monitoring were positive reflux,and 4 out of 17 patients had reflux esophagitis in endoscopic examinations.The symptoms were improved in 58%patients(7/12) by regular acid-suppression therapies.③There was no statistical difference beween NE and HS groups in dominant frequency and power of MEGG.However,the percentages of normal rhythm in preprandial and slow wave coupling in pre and postprandial of NE patients were significantly decreased than those in HS.④The ANS function in NE group had no statistical difference compared to those in HS.⑤In follow- up group,no difference was found before and after nitroglycerin sublingually.Four patients had depres- sion.Conclusions The clinical presentations of NE are vary.The symptoms of NE were poorly correla- ted with MCA,but partially correlated with GER,which may represent a special subtype of GERD. Gastric dysmotility and psychological factors might contribute to the pathogenesis of NE.

Objective To explore the clinical efficacy of laparoscopic gastric ulcer perforation repair com-bined with Helicobacter pylori(Hp)cure.Methods Laparoscopic repair was used in the treatment of gastric ulcer perforation in 45 cases,and 42 cases of postoperative infection were combined Hp eradication therapy.Results The average operative time was 52.5min (36 -83min),mean blood 17.2mL(8 -45mL)in the 45 patients,with no sig-nificant intraoperative complications.The mean 4.5d (3 -8d)normally discharged after an average follow -up of 25 months (18 to 36 months)without significant complications and recurrent perforation.In 42 cases infected with Hp,cure rate of 97.6%,inefficiency of 3.4%,2 -year recurrence rate of 4.9%.Conclusion Laparoscopic gastric ulcer perforation is a minimally invasive,safe and effective surgical method.The surgery is simple,minimal trauma, less pain,faster recovery and fewer complications,Hp infected radical surgery combined with Hp eradication has good efficacy,less recurrence and important clinical significance and value.

Objective: To compare the efifcacy and safety of rivaroxaban and warfarin on thrombolytic disease prevention in very elderly patients. Methods: A total of 90 patients with high risk of venous thrombosis treated in our hospital from 2012-03 to 2014-03 were enrolled. The patients' mean age was (82.4±5.5) years and randomized into 2 groups: Rivaroxaban group, patients received oral rivaroxaban 10 mg/day,n=44 including 34 male and 10 female; Warfarin group, patients received oral warfarin, INR was monitored and kept at stable level of 1.6-2.5,n=46 including 38 male and 8 female. All patients were followed-up for 12 months. Hemoglobin and platelet levels, coagulation, liver and kidney functions, end point events were monitored before and 1, 3, 6, 12 months after treatment. Major efficacy endpoints included all-cause death, recurrent or new onset of venous thrombosis, pulmonary embolism, cerebral and cardiovascular events; major safety endpoints included massive hemorrhages, clinically relevant bleeding and worsening of liver, kidney functions. Results: No patient died during follow-up period. The average INRs in Warfarin group were (2.02±0.46), (1.98±0.54), (2.03±0.56) and (2.04±0.46) at 1, 3, 6 and 12 months of treatment. Efficacy and safety were similar between 2 groups, Warfarin group had 7 patients with massive hemorrhages at 12 months of treatment and it was 2 patients more than that in Rivaroxaban group which had no statistic meaning. Hemoglobin and platelet levels, coagulation, liver and kidney functions were similar between 2 groups.Conclusion: Oral rivaroxaban was effective for preventing thromboembolic disease in very elderly patients, 10 mg/day was a safe dose; efifcacy of rivaroxaban was similar to warfarin while it was easier to use and with better compliance.

Objective: To establish a method to determine 4 active ingredients in Jindan tablets by HPLC.
Methods: Agilent Eclipse X DB C₁₈ (4.6 mm×250 mm, 5 μm) column was adoped using acetonitrile (phase A) -0.1% phophoric acid solution (phase B) as the mobile phase with gradient program at the flow rate of 1.0 mL·min^-1, the detection wavelength was 270 nm, Column temperature was set at 30 ℃.
Results: The linear ranges of gentiopicrin, polydatin, quercetin and emodin were 7.875-78.75 μg·mL^-1（r=0.999 9）, 6.75-67.50 μg·mL^-1（r=0.999 7）, 7.726-77.26 μg·mL^-1（r=0.999 4）, 3.809-38.09 μg·mL^-1（r=0.999 8), respectively, the peak area had a good linear relationship with the mass concentration of 4 components, the average recovery were 99.31%, 99.21%, 99.04%, 99.59%, (n=6) respectively, and RSDs were 1.86%, 1.24%, 1.37%, 1.15%, respectively.
Conclusion: This method is reliable, repeatable and stable, and has strong specificity. This method can provide a reference for the quality control and standard improvement of Jindan tablets.