Objective To evaluate the effect of selective oral decontamination (SOD)on reducing incidence of ventilator-associated pneumonia (VAP).Methods Sixty patients hospitalized in an intensive care unit (ICU)for >72 hours and with mechanical ventilation for >48 hours from January to June 2102 were selected for study,patients were ran-domly divided into trial group(n =30)and control group(n=30).All patients received cefotaxime intravenous drip for 4 days,then trial group received oropharyngeal application of tobramycin during the whole process of mechanical ventila-tion,control group topically received saline solution,the incidence and onset time of VAP ,duration of mechanical ventila-tion,length of stay in ICU,and mortality of two groups were compared.Sputum in the trachea was taken periodically for bacterial culture.Results The incidence of VAP in trial group was lower than control group (30.00% vs 63.33%);the onset time of VAP was later than control group ([9.37±6.62]d vs [5.17 ±4.72]d);Overall duration of me-chanical ventilation was less than control group ([7.63 ±6.91 ]d vs [12.26 ±9.36]d);length of stay in ICU was shorter than control group([13.56±7.22]d vs [16.79±11 .16]d)(all P <0.05).There were no significant differ-ence in mortality between two groups(P >0.05).Conclusion SOD is effective for preventing and treating VAP,it can reduce the incidence of VAP,delay onset time of VAP,shorten mechanical ventilation,and reduce length of stay in ICU.

300 ?m ) damage when the islets are rewarmed to 37 ℃ . These novel findings may help to understand the pathophysiology of early loss of islet tissue after transplantation,and may provide a new strategy to improve graft function in the clinical setting of islet transplantation.

Objective To study the pathway of IFN-?-iNOS-NO on T lymphocytic cells in the rats with experimental autoimmune myasthenia gravis (EAMG).Methods Lewis rats were divided randomly into groups EAMG , normal control(NC) and completed Freund's adjuvant control(CFA-C) . The rats were immunized in foot pad, abdomen and back subcutaneouly with the AChR protein extracted from electric organ of Narcine timilei and CFA in the EAMG group, or only with CFA in the CFA-C group. The above-mentioned emulsions were injected again after 4 weeks . At the 7th week after first immunization, T lymphocytic cells in every rat were separated from the spleen. After cultured in vitro for 48 h, the content of IFN-? in the supernatant of cultured T lymphocytic cells was detected by enzyme-linked immunoadsordent assay (ELISA), and the level of NO was examined with Griess reagent method. Results The contents of IFN-? were (81.68?10.23 ) pg/ml in EAMG group,(29.20?5.41) pg/ml in NC group,(31.54?6.12) pg/ml in CFA-Cgroup.The levels of NO were (23.68?7.13 )?mol/L in EAMG group ,(9.05?2.11) ?mol/L in NC group,(10.21?2.67 )?mol/L in CFA-C group.The contents of IFN-? and NO in EAMG group were increased markedly than groups NC and CFA-C(allP

Objective To compare the cerebral vessels stenosis in acute cerebral infarction patients with or without diabetes mellitus.Methods Using case-control study,51 acute cerebral infarction patients with diabetes mellitus and 64 patients without diabetes mellitus were checked by digital subtraction angiography(DSA).The condition of stenosis and obstruct of vessels in intracranial and extracranial were compared.Results Stenosis of intracranial arteries was frequent in both two groups.The main involved arteries included M1 and M2 segments of middle cerebral artery and external cranial segment of internal carotid artery.The rate of cerebrolvascular abnormality in the patients with diabetes mellitus(84.31%) was higher than that in the patients without diabetes mellitus(70.31%).Stenosis of multiple arteries(52.94%),arteriostenosis combined with ulcer or plaque(39.21%) and collateral circulation development(11.63%) were found in diabetic patients,while the rates were 18.75%,17.19% and 31.11%,repectively,in non-diabetic patients.These differences between two groups were statistical significances(all P

Objective To summarize the surgical skills of the pancreaticoduodenectomy via mesenteric approach for the treatment of duodenal gastrointestinal stromal tumors (GISTs).Methods The clinical data of 1 patient with huge duodenal GIST combined with gastrointestinal hemorrhage and liver metastasis who was admitted to the Second Affiliated Hospital of Harbin Medical University in June 2014 were retrospectively analyzed.The patient had continuous bleeding before the operation.The results of computed tomography (CT) showed that there was a solid tumor below the liver and in front of the right kidney,with the size of 12.2 cm × 8.1 cm,inferior vena cava was squeezed by the tumor,a solid tumor was detected in the right lobe of liver,and the colon was suspiciously invaded by the tumor.The patient received pancreaticoduodenectomy,right hemicolectomy and right lobectomy of liver metastases.The patient was followed up by out patient examination and telephone interview up to August 2014.Results The operation time,volume of blood loss and volume of red blood cell (RBC) transfusion were 420 minutes,800 mL and 2 U,respectively,with a full recovery of patients.The duodenal GIST with metastasis tumor and necrosis located at the colon,pancreatis,liver and renal hilum was confirmed by pathological diagnosis.The life quality of the patient was good by follow-up at postoperative month 3.Conclusion In the pancreaticoduodenectomy via mesenteric approach,surgeons perform vigorously the method of mesenteric approach at the first stage of operation,it could maximally reduce the risk of operation and the volume of blood loss.

Radical pancreaticoduodenectomy is the only effective method for the treatment of malignancies in the pancreatic head and the periampulary region.Early determination of the involvement of the superior mesenteric artery (SMA)is important for the selection of the surgical procedure and judgment of the prognosis.The operation should follow the principle of tumor-free and adequate resection range,safe resection margin and complete lymph node resection.For this purpose,we performed the radical pancreaticoduodenectomy via mesenteric approach.The SMA was dissected first,and then the tumor was en-bloc resected.From December 2011 to December 2012,24 patients with tumors in the pancreatic head or the periampullary region received radical pancreaticoduodenectomy via the mesenteric approach at the Second Affiliated Hospital of Harbin Medical University,and the short-term outcome was satisfactory.

ObjectiveTo review the etiology and classification of cholangiectasia. MethodThe clinical data of 1098 patients with cholangiectasia treated from January 2000 to December 2009 were retrospectively analyzed. Results For the 1098 patients, 69 patients (6.3％) had congenital choledochal cyst, and 1029 patients (93.7％) had secondary cholangiectasia which were secondary to 22 diseases, The top 5 of the etiological diseases were bile duct stones (366 patients, 33.3 ％), pancreatic head carcinoma (137 patients, 12.5％), peri-ampullary carcinoma (122 patients, 11.1％), cholangiocarcinoma (68 patients,6.2％),and chronic pancreatitis or pancreatic head cyst (62 patients,5.6 ％). ConclusionsCholangiectasia can be divided into two major categories (congenital and secondary). Congenital choledochal cyst accounted for 6.0％, secondary cholangiectasia accounted for 94 ％.The most common etiologies were bile duct stones, pancreatic head carcinoma and peri-ampullar carcinoma.

Objective To study the effects of dendritic cells (DC) modified with transforming growth factor ?1 (TGF-?1) gene on experimental autoimmune myasthenia gravis (EAMG) in Lewis rats. Methods 30 female Lewis rats were divided randomly into 6 groups: normal group, EAMG group, DCs treatment group, pcDNA_3-TGF-?1-DCs treatment group, pcDNA_3-DCs treatment group and normal saline group. The rats were immunized with the acetylcholine receptor (AChR) protein extracted from electric organ of Narcine timilei and completed Freund’s adjuvant (CFA) in the experiment groups except normal group. 2?106 pcDNA_3-TGF-?1-DCs/rat were injected subcutaneously into the backs of the rats that had been immunized 5 days earlier with AChR+CFA. The rats in DCs treatment group, pcDNA_3-DCs treatment group and normal saline group were injected in parallel with untreated DCs, pcDNA_3-DCs and normal saline respectively. Then the clinical manifestations were observed everyday. And 7 weeks after the first immunization, repetitive nerve stimulation, detection of acetylcholine receptor antibody (AChRab) and ultrastructural study of neuromuscular junction (NMJ) were performed. Results (1) The mild symptoms were observed on 1 or 2 rats in the experiment groups except normal group after a week, which lasted for 2 to 5 days. After about 5 weeks, the rats in EAMG group, DCs treatment group, pcDNA_3-DCs treatment group and normal saline group presented some symptoms at different degree like myasthenia gravis, and only one of the rats in pcDNA_3-TGF-?1-DCs treatment group presented mildly decreased activity. (2) The significant decrement of repetitive nerve stimulation were found in EAMG group, DCs treatment group, pcDNA_3-DCs treatment group and normal saline group(16.75?6.13, 17.75?7.81, 18.25?8.22 and 16.50?7.14, respectively), but there was no attenuation in pcDNA_3-TGF-?1-DCs treatment group and normal group(3.20?3.70 and 5.60?2.70, respectively). The percentage of decrement in pcDNA_3-TGF-?1-DCs treatment group was lower than that in EAMG group(5.60?2.70 and 16.75?6.13, respectively,P0.05). (4) The combined AChRs in NMJ of the rats in pcDNA_3-TGF-?1-DCs group were higher than that in EAMG group, and the structure changes of the synapse were relieved.Conclusion It suggests that DCs, transfected with pcDNA_3-TGF-?1, when injected subcutaneously into Lewis rats with incipient EAMG, could inhibit the production of AChR-Ab, relieve the pathologic changes in NMJ and ameliorate the development of EAMG.

Objective To investigate the radiation dose to the lens of patients in temporal bone CT scanning with different protocols. Methods With the same values of kV and effective mAs, the tranaxial and coronal scans of exsomatize cadaveric head was performed with conventional sequential scan mode,routine multi-slice helical scan and modified multi-slice helical scan, respectively. The values of CT volume dose index (CTDIvol) and dose length product (DLP) at various scanning mode were anylyzed, and effective doses of subject were calculated. Organ doses of the lens were measured with thermoluminescence dosimetry (TLD). Results When sequential scan mode was selected, gross effective dose was 1.21 mSv,while organ doses to lens were 50.96 and 1.73 mGy separately in axial and coronal slice scan,respectively. Effective dose was 0. 803mSv at helical scanning, while dose to lens was 40. 17 mGy. With modified helical scan mode, the effective dose was similar to routine helical scan, but dose to lens was 10.33 mGy which was significant lower than that of routine helical scan (40.17 mGy). Conclusions With the same values of kV and effective mAs, the effective doses and lens dose obtained in sequential axial and coronal scan were 1.51 times and 1.31 times higher than helical scan, respectively. With modified helical scan mode thinner slice images could be used to reformat axial, coronal and sagittal plane images, and lens dose was reduced by 74.3%. The modified helical CT scan mode of temporal bone could be selected in the clinical application.

Objective To emphasize the correlation and concordance of electronic medical record through analysis of frequently asked problems on handwritten medical record.Methods The problems of electronic medical record were classified and found the typical cases to analyze.Results In order to improve the quality of medical record,the quality control of electronic medical record must be strengthened and the phenomenon that some doctors pay attention to hand-written med-ical record more than electronic medical record must be overcame.Conclusion The normative management of electronics medical is strengthened that is fundamental guarantee for paper-based medical records.