Objective To observe the effect of L-carnitine on plasma soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein in maintenance hemodialysis (MHD) patients.Methods Forty-six cases of MHD patients were enrolled as MHD group,and 40 cases of the same period healthy subjects were enrolled as control group.The levels of plasma sTWEAK protein,high-sensitivity C-reactive protein (hs-CRP),interleukin (IL)-6 and insulin-like growth factor (IGF)-1 were measured by enzyme-linked immunosorbent assay (ELISA).Twenty-six MHD patients with the levels of sTWEAK protein higher than control group mean value as treatment group,were treated for L-carnitine 1.0 g in 0.9％ sodium chloride solution 20 ml after hemodialysis by intravenous injection one time per week.Twenty MHD patients with the levels of sTWEAK protein lower than or equal to control group mean value as non-treatment group.The changes of sTWEAK protein,IGF-1,grip strength and protein energy waisting (PEW) were observed after 3 months treatment.Results The levels of plasma sTWEAK protein,IL-6 and hs-CRP in MHD group were higher than those in control group [(464 ± 102) ng/L vs.(346 ± 159) ng/L,(986.54 ± 123.12) ng/L vs.(407.12 ± 180.25) ng/L,(18.8 ± 2.9) mg/L vs.(1.0 ± 1.2) mg/L],there were significant differences (P＜ 0.05).Compared with non-treatment group,the levels of plasma sTWEAK protein,IL-6 and hs-CRP in treatment group after treatment of 3 months were decreased [(126 ± 92) ng/L vs.(243 ± 103) ng/L,(799.45 ± 105.34) ng/L vs.(966.04 ± 113.11) ng/L,(13.7 ± 1.9) mg/L vs.(26.8 ± 2.8) mg/L],IGF-1 was increased,grip strength was increased,PEW was improved,there were significant differences (P ＜ 0.01 or ＜ 0.05).The body mass index in treatment group was more than that in non-treatment group,but there was no significant difference (P ＞ 0.05).Conclusions L-carnitine can reduce the levels of plasma sTWEAK protein in MHD patients,reduce inflammatory reaction,improve the levels of IGF-1,increase strength,improve the PEW.

Objective To investigate the relationship between soluble tumor necrosis factor-like weak inducer of apoptosis levels (sTWEAK) and cardiovascular events in patients with maintenance hemodialysis (MHD).Methods A prospective cohort study was conducted in 64 MHD patients(MHD group).The plasma level of sTWEAK was measured by enzyme-linked immunosorbent assay,N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive C-reactive protein (hs-CRP) levels were measured by enzyme-linked immunofluorescence method,left ventricular end-diastolic diameter (LVEDd),left ventricular posterior wall thickness (LVPWT),end-diastolic ventricular septal thickness (IVST),left ventricular ejection fraction (LVEF) was determined by echocardiography.The general situation,clinical indicators and occurrence of cardiovascular events of MHD patients were recorded and followed up for 2 years.Fifty healthy people were selected as control group.Results The plasma level of sTWEAK was higher in MHD group than that in control group [(589 ± 122) ng/L vs.(346 ± 127) ng/L],and there was significant difference (P＜ 0.01).During the follow-up period,12 patients underwent cardiovascular events(3 patients died).The plasma level of sTWEAK in cardiovascular event patients was significantly higher than that in non-cardiovascular event patients (695 ng/L vs.458 ng/L),and there was significant difference (P ＜ 0.01).The plasma level of sTWEAK was positively correlated with NT-proBNP in MHD patients(r =0.698,P ＜ 0.05).Logistic repression analysis showed that sTWEAK was the predictor of cardiovascular events of MHD patients.Conclusion The plasma level of sTWEAK probably predicts the ocurrence of cardiovascular event in MHD patients.

Objective To compare the clinical effects between hysteroscopic electroresection and open hysterectomy in the treatment of intrauterine benign diseases. Methods A total of 58 women with intrauterine benign received hysteroscopic electroresection (hysteroscopic group) and 60 women underwent open total hysterectomy (control group). The operating time, hospital stay, postoperative recovery and cure rates were compared between the two groups, respectively. Results The operating time was 68.4?20.6 min in control group and 55.2?19.7 min in hysteroscopic group ( t=-3.555, P =0.000). The postoperative hospital stay was 7.2?1.8 d and 4.5?1.5 d in control and hysteroscopic group, respectively ( t=-8.836, P =0.000). The time to resume regular work was 64.4?25.3 d in control group and 37.2?7.8 d in hysteroscopic group ( t=-7.835, P =0.000). The cure rates in control and hysteroscopic group were 100% (60/60) and 94.7% (54/57), respectively ( ? 2 =1.477, P =0.224). Conclusions Hysteroscopic electroresection gives good short-term therapeutic effects and quick postoperative recovery. It may replace hysterectomy in part of patients with intrauterine benign diseases.

Objective To investigate the effect of implanting uncovered self-expandable metal stent for treatment of distal malignant biliary obstruction through endoscope.Methods The effect of therapy about implanting uncovered self-expandable metal stents to 16 patients who had unsectable malignant tumors companing with obstructive jaundice through endoscope was reviewed. Results Fifteen of the studied patients were implanted uncovered self-expandable metal stents successfully (94%), for their internal drainage were patent. At the seventh and fourteenth day after implantation, liver function and B-ultrasound were rechecked. Compared to the data before operation, total bilirubin, direct bilirubin and transaminase declined respectively (P

Objective To study the causes, epidemiology and control measures of outbreak of MRSA nosocomial infections. Methods The epidemiologic survey was carried out for 7 cases infected with MRSA within short term in the department of neurosurgery. The risk factors and epidemiological trends was analyzed. Results Some measures, such as strengthening training of health worker with MRSA prevention and control knowledge, enhancing their awareness of infection prevention and control, and controlling patients infected with MRSA effectively using warning mechanisms of MRSA infection outbreaks, should be taken to control the outbreak and spread of MRSA promptly. Conclusions Nosocomial MRSA infection is preventable and controllable.

Objective To judge the hospital crisis and to provide the approaches and strategies to avoid the hospital crisis. Methods To conduct specific diagnosis of important risk factors of hospitals using expert diagnostics and crisis identification. Results Combined with the index system and weight affecting public hospitals' crisis, to focus on preventing risk factors directly, which had severe affection and put great weight on hospital crisis. To raise up the containments, managing strategies and mechanisms for public hospitals' crisis. Conclusions It is an effective method to warn and prevent hospital crisis by the way of establishing public hospital crisis value with fuzzy comprehensive evaluation system.

Objective To evaluate the clinical and imaging features of the sellar region lesions in children.Methods The clinical and imaging features of 112 cases with sellar region lesions were analyzed retrospectively,which were confirmed by pathology.Results 37 cases were craniopharyngiomas, which had two main symptoms of intracranial hypertension(57%)and diabetes insipidus(11%).On imaging it demonstrated as a calcified cystic tumor(81%).18 cases were gliomas, the main clinical feature of which was decreased visual acuity,13 of them were pilocytic astrocytoma, which manifested as a solid tumor with significantly enhancement(94%).16 cases were germ cell tumors,the main complaint was diabetes insipidus (75%),13 of them were germinoma, which showed iso-high density on CT and moderate enhancement after administration of contrast.And it showed high signal intensity on DWI.7 cases were hamartoma,86% patients of which showed gelasmus epilepsy,the imaging showed iso-signal masses with no enhacement in the hypothalamic papillary region.5 cases were LCH,80% of which had the complaint of diabetes insipidus,imaging findings manifested as thinkened pituitary stalk and loss of hyperintensity of posterior pituitary on T1WI.3 cases were pituitary tumors.23 cases were Rathke's cleft cysts,3 cases were arachnoid cyst.Most of the patients presented with headache.Conclusion The clinical and imaging features shows some specific features, which is helpful to improve the correct rate of diagnosis and provide the basis for further treatment.

AIM: The aim of the present study is to investigate changes of five biochemical markers of bone turnover during the formation of ovariectomized rat model. METHODS: Three-month-old female SD rats were divided randomly into ovariectomized (OVX) group, sham-operated (sham) group and control group. Five biochemical markers of bone turnover levels, including serum osteocalcin (OC), total alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), tartrate-resistant acid phosphatase (TRAP) and hydroxyproline (HYP) were measured before and at 1, 1.5, 2, 2.5, 3 and 4 months after surgery. The right proximal tibias of rats were excised at the same time point for histopathological observation. RESULTS: Serum OC, ALP, BALP, TRAP and HYP levels in OVX group were significantly higher than that in sham group. As regard to the time of peak level arrived, the sequence of changes was as follows: TRAP/HYP→OC→ALP/BALP. There was a significant positive correlation between five markers. The pathological changes of trabecular bone in OVX group were only observed 3 months after surgery. CONCLUSION: The results suggest that postmenopausal osteoporosis has a high bone turnover rate. During the formation of ovariectomized rat model, changes of bone resorption markers precede changes of bone formation markers. Serum OC, ALP, BALP, TRAP and HYP are sensitive to evaluate the bone loss in the earlier stage of postmenopausal osteoporosis.

Objective To investigate the clinical features of 4 cases with systemic lupus erythematosus (SLE) complicated by chylothorax and chylous ascites.Methods Clinical manifestations,laboratory examinations,treatment and prognosis of 4 patients with SLE complicated by chylothorax and chylous ascites,who were admitted to our center in recent 13 years,were retrospectively analyzed.Results Four patients were female.The average age of SLE at presentation was 38 years (ranging from 31 to 47 years of age).The average disease duration of chylothorax and chylous ascites was 6.5 months (ranging from 3 to 12 months).Of the 4 patients,3 were complicated with chylothorax and chylous ascites,and 1 with chylothorax.Three patients were treated with corticosteroid,and 2 patients were treated combined with immuno-suppressive agents (cyclophosphamide or ciclosporin A).Chylothorax and chylous ascites improved in 1 patient.Conclusion The clinical manifesta-tions of chylothorax and chylous ascites are relatively rare in patients with systemic lupus erythematosus,and more attention should be given to improve the quality of life of these patients.

BACKGROUND: Ghildren refractory clubfoot includes idiopathic multiple contracture, untreated idiopathic clubfoot in older children and failure cases of repeated operations. It is very difficult to treat this type of children patients. It has important significance in the exploration of new therapeutic methods.OBJECTIVE: To improve the therapeutic effectiveness of refractory clubfoot in children with Ilizarov method.DESIGN: a self-controlled study.SETTING: Department of Orthopedics, Nanjing Children' s Hospital, Nanjing Medical University.PARTICIPANTS: Totally 3 cases of children idiopathic multiple contracture, 2 cases of idiopathic clubfoot in children aged more than 10 years old without treatment and 6 cases of postoperative recurrent idiopathic clubfoot were admitted by the Department of Orthopedics of Nanjing Children' s Hospital Affiliated to Nanjing Medical University during 1999 to 2000. All cases manifested abnormal ankylosis and shortening deformity in foot.METHODS: Twelve refractory clubfeet in eleven patients were treated with the Ilizarov method. After achilles tendon lengthening and posterior release,kieschner' wires or olive wires with tension were penetrated through multiple planes of the middle lower 1/3 of tibia, calcaneus and the 1st to the 5th metatarsals, which were fixed respectively to external bone fixer of a ring,half-ring or horseshoe shape and connected with each other by multiple screw bars into a three-dimensional external bone fixing set. Plantarflexion, inversion, adduction and shortening deformities were corrected by the adjustment of the distance between each part of the external bone fixing set through extension, compression, and rotation, etc., and navicular and cuboid osteotomy.MAIN OUTCOME MEASURES: All 11 cases were followed up for 2 to 10 years with an average period of 4. 5 years. Indices like foot morphology,talocrural articualr activity range and deformity correction were observed during the follow up.RESULTS: The results were excellent in 5 cases (6 feet), good in 4 cases (4 feet), fair 2 cases(2 feet) according to the Garceau standard scale. The rate of excellent and good clinical results was 83.3%. Mild forefoot adduction was left in 2 feet of 2 cases and quite obvious tarsal articular ankylosis was found in 4 feet of 4 cases; however, there were no significant differences of gait and load bearing between these patients and normal children.CONCLUSION: The Ilizarov technique is a safe and effective method for the treatment of refractory children clubfoot while its indications should be controlled strictly.