Objective To investigate the effect of nicardipine on perioperative insulin sensitivity in patients with essential hypertension(EH). Methods Thirty-eight patients undergoing lobectomy continuously after induction of anesthesia in group N, while normal saline was infused in group C instead of nicardipine. Blood samples were taken immediately before induction of anesthesia(T_0), 2 h after skin incision(T_1) ,4 h after surgery(T_2) and 24 h after surgery(T_3). Blood glucose(BG) and plasma insulin (Ins) were measured. The Insulin sensitivity index (ISI) was calculated. Results Values of BG at T_2and T_3 in group C were higher than those at T_0 (P<0. 05). Value of Ins at T_2 in group C was higher than that at T_0 (P<0. 05),which at T_3 in group C was significantly higher than that at T_0 (P<0. 01). ISI at T_2 in group C was lower than that at T_0 (P<0. 05) ,which at T_3 in group C was lower significantly than that at T_0 (P<0. 01). Values of BG and Ins at T_3 in group N were higher than those at T_0 (P<0. 05), ISI at T_3 in group N was lower than that at T_0 (P<0. 05). Value of BG at T_2 was significantly lower in group N than that in group C(P<0. 05). Value of Ins at T_3 was significantly lower in group N than that in group C(P<0. 01). ISI at T_2 and T_3 in group N was min~(-1) infused continuously during and after lobectomy can increase significantly insulin sensitivity and improve postopertive insulin resistance state in EH patients.

Objective To investigate the effect of milrinone on the gastric intramucosal pH (pHi), endotoxemia and systemic inflammatory response during cardiopulmonary bypass (CPB) Methods Twenty adult patients undergoing valve replacement were randomly divided into two equal groups of ten patients each: control group (C) and milrinone group (M) In group M milrinone 30?g?kg -1 was given as an intravenous bolus after induction of anesthesia followed by 0 5?g?kg -1 ?min -1 infusion, while in group C normal saline (NS) was given instead of milrinone Patients with ejection fraction (EF)

Objective To investigate the etiology of early postoperative hyperbilirubinemia after liver transplantation.Methods The clinical data of 87 cases of liver transplantation and the etiology of early postoperative hyperbilirubinemia after liver transplantation were analyzed.Results The incidence of early postoperative hyperbilirubinemia after liver transplantation was(52.87 %).In 21 postoperative complications,17((80.95 %)) were associated with hyperbilirubinemia.The causes of hyperbilirubinemia were as follows in turn: ischemic-reperfusion injury(n=(25,28.73 %)),complications of(common) bile duct(n=23,(26.44 %));acute rejection(n=19,(21.84 %));others(n=13,(14.94 %)).(Conclusions) The early postoperative hyperbilirubinemia is the most common clinical manifestation in(patients) undergoing liver transplantation and can be taken as a reliable clinical mark for the postoperative complications and liver functions.The etiology of early postoperative hyperbilirubinemia after liver transplantation is very complicated.Early diagnosis and treatment is helpful to improve the survival of patients undergoing liver transplantation.

Objective To evaluate the safety and effectiveness of Stoppa approach combined with iliac incision in periacetabular osteotomy for treatment of hip dysplasia.Methods From September 2011 to July 2012,18 patients (20 hips) with hip dysplasia were performed periacetabular osteotomy through Stoppa approach combined with iliac incision.There were 15 female patients with 17 hips and 3 male patients with 3 hips.The average age was 29 years old (range 19 to 35).The surgical incision included two parts with the abdominal transverse incision (Stoppa approach) and the iliac incision (the lateral window of ilioinguinal approach).The duration of surgery,length of incision,intraoperative blood loss,and amount of allogeneic blood transfusion were measured.The clinical function,radiographic parameters,and operative complications were analyzed at 12 months follow-up.Results The mean operation time was 145 min (range,125-180 min).The mean incision length of Stoppa approach was 7 cm (range,5-10 erm) for the abdominal part and 6 cm (range,4-8 cm) for the iliac part,and the average of total incision length was 13 cm (range,12-16 cm).The mean blood loss during operation was 800ml (range,500-1 600 ml).The mean amount of allogeneic blood transfusion was 1 161 ml (range,400-2 400 ml).The mean duration of follow-up was 19.6 months (range,14-22 months).Compared to the preoperative data,both postoperative Harris hip score and center-edge angle improved significantly,with a mean increase of 13.2±6.0 and 22.5°±4.5° respectively.The mean Harris hip score improved form 80.3±8.5 preoperatively to 93.5±5.2 postoperatively at the time of 12 months follow-up.The average center-edge angle improved from 7.5°±5.4° preoperatively to 30.0°±4.6° postoperatively.All of the osteotomies except two pubic osteotomies healed at the time of three months follow-up.The two pubic osteotomies were treated with protected weight bearing and had a delayed union until the six months follow-up.The mean time of osteotomies union was 3.3 months.Complications included three transient]ateral femoral cutaneous nerve palsies which completely resolved within three months after oral medicine therapy.There were no major neurovascular complications,no infection,no incision hernia or any other surgical complications.Conclusion Stoppa approach combined with iliac incision is a safe and effective approach for periacetabular osteotomy.It is an alternative to conventional ilioinguinal approach for treatment of mild hip dysplasia.

National traditional Chinese medicine (TCM) master professor Ban Xiuwen had rich experiences on treatment of gynecological diseases with unique insights on diagnosis and treatment for disorders of menstruation, leukorrhea, pregnancy and delivery. FemaleYin-Wei, which was a gynecological disorder, was recorded in the book ofHuang-Di Nei-Jing. However, due to different reasons, TCM study on femaleYin-Wei was far less than the study on male impotence. ProfessorBan Xiuwen had specific considerations for this disease on the book of Treatment of Miscellaneous Gynecological Diseases. In his understanding, femaleYin-Wei was due to four aspects, which were the innate deficiency, yang deficiency and coldness of the uterus; seven emotion damage, liver-qi soothing disorder; spleen-stomach deficiency,qi-blood deficiency; and phlegm-dampness stasis,qi stagnation. Through the analysis and study on case records of femaleYin-Wei treatment by national TCM master professorBan Xiuwen, this article briefly elaborated professorBan Xiuwen’s understandings on femaleYin-Wei treatment from etiology, pathogenesis, treatment according to syndrome differentiation, and clinical experiences. Two femaleYin-Wei cases treated by professorBan Xiuwen were given as examples in order to analyze the etiology, pathogenesis, treatment according to syndrome differentiation and treatment experiences in details. The therapeutic effects of both cases were obvious, which were also important study documents.

Objective To compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) with transperitoneal laparoscopic partial nephrectomy (LPN).Methods From July 2009 to March 2013,114 patients were treated in our hospital due to renal carcinoma,including RAPN in 45 patients and LPN in 69 patients.Their data were retrospectively reviewed.Clinical and pathological variables,R.E.N.A.L nephrometry score,operation time (OT),warm ischemia time (WIT),estimated blood loss (EBL),drainage volume,the length of hospitalization,estimated glomerular filtration rate (eGFR) outcomes,and complications were analyzed.Results There were no significant differences between the RAPN and LPN group with respect to patient age,sex,tumor laterality,size,R.E.N.A.L nephrometry score,the rate of hilar tumor and preoperative eGFR (P＞0.05).The median OT was shorter in the RAPN group than that in LPN group (165 min vs.196 min,P＜0.05).The median WIT was shorter in the RAPN than that in LPN group (21 min vs.25 min,P＜0.05).However,there were no significant differences in the postoperative eGFR and changing of eGFR within the 2 groups (P＞0.05).The rate of transfusion was similar between the RAPN (2/45) and LPN (4/69) group (P=0.72).There was also no significant difference in EBL (P=0.16).The drainage volume was also similar within two groups (167 ml vs.163 ml,P=0.81).The length of hospitalization was more favorable in the RAPN group (6.5 d vs.8.0 d,P=0.01).In RAPN group,27 cases were clear-cell carcinoma,5 cases were papillary cell carcinoma,2 cases were chromophobe cell carcinoma and 1 1 cases were angioleiomyolipoma.In LPN group,45 cases were clear-cell carcinoma,9 cases were papillary cell carcinoma,3 cases were chromophobe cell carcinoma and 12 cases were angioleiomyolipoma.There was no difference of pathological types between LPN and RAPN groups (P＞0.05).The rate of positive surgical margins was 0％ (0/45) in RAPN group and 1.4％ (1/69) in LPN group (P=0.69).The rates of complication requiring intervention (Clavien grade Ⅲ) were 2.2％ (1/45) and 2.9％ (2/69) in the RAPN and LPN group,respectively (P＞0.05).Median follow up was 12 (4-36) months in the RAPN and 13 (5-34) months in the LPN group.No local recurrence or metastasis occurred in two groups.Conclusions Early comparative outcomes suggest that RAPN has a significant benefit over the LPN in terms of OT,WIT and hospital stay.Meanwhile,it offers equivalent prognosis and postoperative renal function preservation compared with LPN.

Objective To investigate the protective function of panax notoginseng saponins(PNS) on grafted liver during ischemia-reperfusion in rat with orthotopic liver transplantation.Methods After establishing rat orthotopic liver transplantation model,the rats were randomly divided into three groups:the experimental group(P),the control group(N),and sham operation group(S).The levels of serum ALT and AST were(determined),the hepatic pathohistological changes were observed,the expression of caspase-3 and TNF-? were examined by immunohistochemistry,and the apoptotic hepatocytes in grafted liver were detected by TUNEL method.Results The levels of ALT,AST,and the expression of caspase-3 and TNF-?,and apoptotic cells in grafted liver were significantly higher in the control group than that in the experimental group.(Conclusions) PNS can protect the grafted liver from injury during ischemia-reperfusion in rat orthotopic liver transplantation.

Objective To evaluate the value of intra-cavitary contrast-enhanced ultrasound (IC-CEUS) via abdomen in fistulas difficult to diagnose before operation.Methods Clinical data of 12 patients with preoperative clinical suspicion of Crohn's Disease (CD) complications of fistula were enrolled in the study.Colonoscopy,cystoscope,or CT/MR has not confirmed the diagnosis of intra abdominal fistulas.IC-CEUS were performed by locally-injection of contrast agent in abdominal abscess,observing fistula and the relationship with the adjacent organs in CEUS mode.Diagnostic criteria were surgical findings.Results Fistulas in 10 patients were detected by IC-CEUS,including 7 cases of Ileo-mesenteric fistuls,2 cases of il eo-vesical fistulas,and 1 case of colo-vesical fistula.The accuracy rate of IC-CEUS in diagnosis of fistulas difficult to diagnose before operation in Crohn's disease was 83.3％ (10/12).No severe adverse events occurred during and after IC-CEUS procedure.Conclusions Our preliminary study shows that IC-CEUS is feasible in detecting abdominal fistula with high accuracy.It might be used as the alternative imaging tech nique for detecting fistulas when CT and MR are insufficient.

0.05). PBF was still increased more then normal values 1 years after OLT(P

Objective To summarize the clinical experience of standard piggyback liver transplantation(SPBLT) and modified piggy-back liver transplantation(MPBLT) in the treatment of Wilson′s disease(WD).Methods The clinical records of 29 cases of WD who underwent piggyback liver transplantation over the recent 12 years were analyzed retrospestively.Among them,there were 22 male and 7 female patients,with 6cases aged 8-14y and 23 cases aged 24-37y,who underwent liver transplantation because of chronic advanced liver disease(18cases),fulminant hepatic failure(2 cases),or with normal liver function(9 case),and among them,24 cases showed neurological dysfunction.The modes of operation included SPBLT(13 cases) and MPBLT(16 cases).Results The patients were followed up for 1 month-12 years with the median follow-up time of 47 months.Four patients died in the perioperative period,of which 2 died of hepatic failure due to obstruction of hepatic venous return after SPBLT,and 2 died of hepatic artery thrombosis and bile leakage combined with severe infection.The recipient survival rate at 1 year and 3 years was 86% and 79% respectively.One patient has survived for 12 years.All the levels of serum copper and copper-protein recovered to normal in four weeks post-operatively.Neurological symptoms improved in varying degrees after operation.Conclusions WD patients who undergo PBLT can expect a satisfactory clinical outcome and a good quality of life,and MPBLT can effectively reduce the complications of operation and improve the operation survival rate.