Objective To understand the risk factors for postoperative pulmonary infection in patients undergoing spinal surgery,and put forward the intervention measures.Methods Patients who underwent spinal surgery in a hospital from May 2008 to June 2016 were analyzed retrospectively,they were divided into non-pulmonary infection group and pulmonary infection group according to whether they had postoperative pulmonary infection,clinical data of two groups were compared.Results A total of 612 patients who underwent spinal surgery were monitored,43 had postoperative pulmonary infection,incidence of postoperative pulmonary infection was 7.03％.Univariate analysis showed that 14 risk factors for pulmonary infection in patients after spinal surgery were as follows:length of hospital stay≥30 days,long-term smoking,chronic pulmonary disease,diabetes,number of surgical level≥2,general anesthesia,duration of operation≥4 hours,bleeding≥500mL,time of bed rest≥7 days,use of glucocorticoid,indwelling urinary catheter,mechanical ventilation,serum albumin＜30 g/L,blood glucose≥1 1mmol/L,and hemoglobin＜90 g/L(P＜0.05);while atomization inhalation was a protective factor(P＜0.05).Multivariate logistic regression analysis showed that 6 independent risk factors for pulmonary infection in patients after spinal surgery were as follows:length of hospital stay≥30 days,long-term smoking,chronic pulmonary disease,general anesthesia,time of bed rest≥7 days,and use of glucocorticoid(all P＜0.05),while atomization inhalation was a independent protective factor(P＜0.05).Conclusion Patients with pulmonary infection after spinal surgery is related to multiple factors,comprehensive and effective preventive measures should be taken according to the risk factors of postoperative pulmonary infection,so as to reduce the incidence of postoperative pulmonary infection in spinal surgery patients.

Liver ischemia-reperfusion injury is the leading cause of delayed recovery of liver function and dysfunction after operation.Some studies have shown that PI3K/Akt signaling pathway is activated during ischemia and reperfusion,which plays a protective role on the liver by inhibiting or enhancing the expressions of downstream target proteins.Therefore,PI3K/ Akt signaling has become an important target pathway for preventing and improving hepatic ischemia-reperfusion injury.This review summarized the research progresses of PI3K/Akt signaling pathway in hepatic ischemia-reperfusion injury.

BACKGROUND: In recent years, the rapid development of medical and tissue engineering has provided more choices for making nerve conduit preparation. OBJECTIVE: To review the application of nerve conduits in the repair of peripheral nerve injury. METHODS: The first author retrieved the CNKI and PubMed databases to search relevant articles published from 2010 to 2016. The key words were "nerve conduit, peripheral nerve" in Chinese and English, respectively.RESULTS AND CONCLUSION: The nerve conduit materials are mainly classified into biotype and non-biotype. Biotype materials mainly include muscle, amniotic membrane, vein and small intestinal submucosal layer. The non-biotype materials include chitosan, collagen, silk fibroin, polylactic acid, polycaprolactone, polyaniline and silicone tubes. Some materials currently have been approved to enter the clinical stage. There are more or less problems in the clinical application of nerve conduits in the repair of peripheral nerve injury. For example, the length of a defect that can be repaired is limited; the mechanical properties and mechanical properties are not exactly matched with nerve regeneration; the degradation rate is inconsistent with the rate of nerve regeneration; and poor biocompatibility exists.

Single particle analysis, which can be regarded as an average of signals from thousands or even millions of particle projections, is an efficient method to study the three-dimensional structures of biological macromolecules. An intrinsic assumption in single particle analysis is that all the analyzed particles must have identical composition and conformation. Thus specimen heterogeneity in either composition or conformation has raised great challenges for high-resolution analysis. For particles with multiple conformations, inaccurate alignments and orientation parameters will yield an averaged map with diminished resolution and smeared density. Besides extensive classification approaches, here based on the assumption that the macromolecular complex is made up of multiple rigid modules whose relative orientations and positions are in slight fluctuation around equilibriums, we propose a new method called as local optimization refinement to address this conformational heterogeneity for an improved resolution. The key idea is to optimize the orientation and shift parameters of each rigid module and then reconstruct their three-dimensional structures individually. Using simulated data of 80S/70S ribosomes with relative fluctuations between the large (60S/50S) and the small (40S/30S) subunits, we tested this algorithm and found that the resolutions of both subunits are significantly improved. Our method provides a proof-of-principle solution for high-resolution single particle analysis of macromolecular complexes with dynamic conformations.
Algorithms ; Computer Simulation ; Cryoelectron Microscopy ; methods ; Crystallography, X-Ray ; Humans ; Macromolecular Substances ; chemistry ; Models, Molecular ; Protein Conformation ; Ribosomes ; chemistry

OBJECTIVETo investigate the feasibility and safety of adult-to-adult living-related donor liver transplantation using a right lobe graft.

METHODSThe clinical data of 2 cases of living-related donor liver transplantation performed between July, 2010 and November, 2010 were analyzed.

RESULTSLiver transplantation was performed using a right lobe graft including the middle hepatic vein in one case and a right lobe graft without the middle hepatic vein in the other. The ratio of graft volume to standard liver volume was 46.2% and 47.3% in the two cases, with GR/WR of 0.83 and 0.80, and donor residue liver of 42.1% and 39.5%, respectively. The donor operation lasted for 6.5 h and 5 h in the two cases with blood loss of about 200-250 ml without blood transfusion. The donors recovered uneventfully without any surgical complications, whose liver function was normal 7 days after the operation, and were discharged 14 days and 16 days after the surgery, respectively. The recipient operation lasted for 8 h and 7 h with blood loss of about 800-1000 ml. The right hepatic vein, hepatic artery, portal vein and bile duct reconstruction were performed by end-to-end anastomoses in the 2 recipients. Bile duct anastomosis stricture occurred in the first recipient 2 months after transplantation and was treated with percutaneous transhepatic cholangiography and drainage. The second recipient recovered smoothly without any complications. The recipients have so far survived 9 months and 5 months, respectively.

CONCLUSIONAdult-to-adult living-related donor liver transplantation is a safe and effective option for treatment of end-stage liver diseases in the context of cadaveric liver graft shortage.

Adult ; Female ; Hepatectomy ; Humans ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; methods ; Living Donors ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo summarize the experience of donor liver procurement and preparation in liver transplantation.

METHODSOne hundred and twenty-six cases of donor liver and kidney procurement and 105 cases of donor liver preparation from August, 2004 to December, 2006 were analyzed. The 105 donor liver grafts were all used for orthotopic liver transplantation.

RESULTSThe warm ischemia time of the graft ranged from 1 to 8.5 min with a mean of 4 min. The time of graft procurement ranged from 19 to 28 min (mean 22.5 min). Donor liver preparation lasted for 38 to 102 min in the 105 cases, with a mean of 51 min. The cold ischemia time of the donor liver was 5.5 to 13 h (mean 8 h). Anatomical variations were identified in 8 of the donor liver grafts.

CONCLUSIONSCold perfusion of the donor liver and repair of the hepatic artery are important procedures in donor liver procurement and preparation. Hemorrhage due to the donor graft should be prevented and the procedures should be performed in close cooperation with the recipient operation.

Adult ; Female ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Organ Preservation ; methods ; Tissue Donors ; Tissue and Organ Procurement ; methods ; Young Adult

Aged ; Aged, 80 and over ; Humans ; Laser Therapy ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Treatment Outcome

OBJECTIVETo compare the hemopoietic reconstitution, immune reconstitution, infection, incidence of graft-versus-host disease (GVHD) and clinical outcome between unrelated donor peripheral blood stem cell (PBSC) transplantation and bone marrow (BM) transplantation for leukemias.

METHODSThe clinical results of 21 leukemia patients receiving G-CSF mobilized PBSC graft from unrelated donors were compared with that of 32 patients receiving unrelated BM transplants.

RESULTSCompared with BM grafts, the PBSC graft contained significantly more nucleated cells (P = 0.000), and resulted in a significantly shorter time-to-neutrophil (12.43 +/- 3.67 vs 16.16 + 2.99 days) and platelet engraftment (14.67 +/- 6.19 vs 21.23 +/- 8.25 days), (P = 0.000 and 0.003, respectively). T cell reconstitution between the two groups differed little after transplantation. The incidences of early-stage infection (42.86% vs 53.13%), the probabilities of acute graft-versus-host disease (aGVHD) (61.90% vs 71.88%), the grades III to IV aGVHD (23.81% vs 15.63%), the chronic GVHD (47.06% vs 43.48%) and the probabilities of relapse (6.90% vs 12.50%) between PBSC and BM groups all has no statistical significance (NS). The 2-year disease free survival (DFS) rates of the two groups were (50.14 +/- 12.00) % and (59.81 +/- 8.99)%, respectively also have no NS.

CONCLUSIONG-CSF-mobilized unrelated donor PBSCs engraft more rapidly in the recipients as compared with conventional BM grafts. The T cell reconstitution, the incidence of infection, the incidence and severity of aGVHD and cGVHD, and the 2-year DFS rates between the two groups all have no significant differences.

Adolescent ; Adult ; Bone Marrow Transplantation ; methods ; Disease-Free Survival ; Female ; Humans ; Leukemia ; surgery ; Male ; Peripheral Blood Stem Cell Transplantation ; methods ; Tissue Donors ; Transplantation Conditioning ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo compare the effect of unrelated donor bone marrow (BM) transplantation and peripheral blood stem cell (PBSC) transplantation in light of hemopoietic reconstitution, immune reconstitution, infection, incidence of graft-versus-host disease (GVHD) and other complications in patients with leukemia.

METHODSThe clinical outcomes of 16 patients receiving unrelated PBSC graft mobilized by granulocyte colony-stimulating factor (G-CSF) were compared with 30 patients receiving unrelated BM transplantation.

RESULTSEngraftment was achieved in 97.83% of the total patients. Compared with BM transplantation group, PBSC graft contained significantly more nucleated cells (P=0.000), resulting in a significantly shorter time-to-neutrophil (16.21-/+3.09 vs 12.81-/+4.15 days, P=0.003) and platelet engraftment (20.31-/+7.19 vs 15.50-/+6.91 days, P=0.035). T cell reconstitution differed little between the two groups at different time points after transplantation. The incidences of early-stage infection were 37.50% and 50.00% (P=0.644) in the PBSC and BM groups, respectively. In PBSC and BM groups, the incidences of grades I to IV acute GVHD (aGVHD) were 56.25% and 70.00% (P=0.456), 18.75% and 13.79% (P=0.661) for grades III to IV aGVHD, and 30.77% and 36.36% (P=0.413) for chronic GVHD (cGVHD), respectively. The nonrelapse transplant-related mortality (TRM) rates were 18.75% in PBSC group and 33.33% in BM group (P=0.295). The relapse occurred in 18.75% and 6.90% (P=0.226) of the patients in the two groups, respectively, and the 2-year disease-free survival (DFS) rates were 62.19% and 56.23% (P=0.615), respectively.

CONCLUSIONG-CSF-mobilized PBSCs allow more rapid engraftment in unrelated donor recipients in comparison with conventional BM, but T cell reconstitution and the incidence of infection between the two groups differ little, nor are there significant differences in the incidence or severity of aGVHD and cGVHD, nonrelapse TRM or 2-year DFS rates between the two groups.

Adolescent ; Adult ; Bone Marrow Transplantation ; methods ; Female ; Graft vs Host Disease ; pathology ; Humans ; Leukemia ; surgery ; Male ; Peripheral Blood Stem Cell Transplantation ; methods ; Tissue Donors ; Transplantation Conditioning ; Transplantation, Homologous ; Treatment Outcome

AIMTo explore the feasibility and safety of greenlight photoselective vaporization of the prostate (PVP) on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) and to evaluate their clinical and voiding outcome.

METHODSA total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score (IPSS), quality of life score (QoL), uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients.

RESULTSAll patients got through the perioperative period safely. The chief advantages of PVP were: short operative time (25.6 +/- 7.6 min), little bleeding loss (56.8 +/- 14.3 mL) and short indwelling catheterization (1.6 +/- 0.8 d). The IPSS and QoL decreased from (29.6 +/- 5.4) and (5.4 +/- 0.6) to (9.5 +/- 2.6) and (1.3 +/- 0.6), respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data (P < 0.05). No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation.

CONCLUSIONPVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

Aged ; Aged, 80 and over ; Humans ; Laser Therapy ; adverse effects ; Male ; Phosphates ; Prospective Studies ; Prostatic Hyperplasia ; surgery ; Titanium ; Treatment Outcome ; Urination Disorders ; epidemiology