Genetic Subtypes and Pretreatment Drug Resistance in the Newly Reported Human Immunodeficiency Virus-Infected Men Aged≥50 Years Old in Guangxi / 中国医学科学院学报

Objective To analyze the genetic subtypes of human immunodeficiency virus (HIV) and the prevalence of pretreatment drug resistance in the newly reported HIV-infected men in Guangxi. Methods The stratified random sampling method was employed to select the newly reported HIV-infected men aged≥50 years old in 14 cities of Guangxi from January to June in 2020.The pol gene of HIV-1 was amplified by nested reverse transcription polymerase chain reaction and then sequenced.The mutation sites associated with drug resistance and the degree of drug resistance were then analyzed. Results A total of 615 HIV-infected men were included in the study.The genetic subtypes of CRF01_AE,CRF07_BC,and CRF08_BC accounted for 57.4% (353/615),17.1% (105/615),and 22.4% (138/615),respectively.The mutations associated with the resistance to nucleoside reverse transcriptase inhibitors (NRTI),non-nucleoside reverse transcriptase inhibitors (NNRTI),and protease inhibitors occurred in 8 (1.3%),18 (2.9%),and 0 patients,respectively.M184V (0.7%) and K103N (1.8%) were the mutations with the highest occurrence rates for the resistance to NRTIs and NNRTIs,respectively.Twenty-two (3.6%) patients were resistant to at least one type of inhibitors.Specifically,4 (0.7%),14 (2.3%),4 (0.7%),and 0 patients were resistant to NRTIs,NNRTIs,both NRTIs and NNRTIs,and protease inhibitors,respectively.The pretreatment resistance to NNRTIs had much higher frequency than that to NRTIs (2.9% vs.1.3%;χ2=3.929,P=0.047).The prevalence of pretreatment resistance to lamivudine,zidovudine,tenofovir,abacavir,rilpivirine,efavirenz,nevirapine,and lopinavir/ritonavir was 0.8%, 0.3%, 0.7%, 1.0%, 1.3%, 2.8%, 2.9%, and 0, respectively. Conclusions CRF01_AE,CRF07_BC,and CRF08_BC are the three major strains of HIV-infected men≥50 years old newly reported in Guangxi,2020,and the pretreatment drug resistance demonstrates low prevalence.

Effects of ulinastatin on intestinal mucosal barrier function in sepsis rats and its effect on wnt signal transduction pathway / 解剖学报

Objective To investigate the intestinal mucosal barrier function protective effect of ulinastatin in sepsis rats and its effect on Wnt/β-catenin signaling pathway. Methods One hundred SD rats were randomly divided into control group, sepsis group, ulinastatin group, XAV939+ulinastatin group and lithium chloride( LiCl) +ulinastatin group. The classical cecal ligation was used to duplicate sepsis model, and the jejunal mucosal injury was evaluated. The levels of inflammatory factors interleukin (IL)-6 and tumor necrosis factor(TNF)-α were detected by ELISA, and the expressions of β-catenin and cyclin D1 were detected by Real-time PCR and Western blotting. We also observed the effect of the Wnt signal pathway blockage by XAV939 or Wnt signal pathway activator by LiCl on ulinastatin protection of intestinal mucosa and proteins related to the Wnt signal pathway. Results The levels of IL-6, TNF-α and intestinal mucosal injury in the sepsis group were significantly higher than those in the ulinastatin group. The mRNA and protein expression levels of β- catenin and cyclin D1 in the sepsis group were significantly higher than those in the control group (P<0.05), After ulinastatin treatment, the expression levels of β-catenin and cyclin D1 mRNA and protein were significantly decreased, and the difference was significant (P<0.05). Compared with the ulinastatin group, combined treatment with XAV939 promoted the protective effect of ulinastatin on the intestinal mucosa of rats, and the protein expression of β-catenin and cyclin D1 was reduced (P<0.05). Combined treatment with LiCl weakened the protective effect of ulinastatin on the intestinal mucosa of rats, and the protein expression of β-catenin and cyclin D1 was increased (P<0.05). Conclusion Ulinastatin may inhibit the Wnt signaling pathway by down-regulating the expression of β-catenin, reduce the expression of inflammatory factors IL-6 and TNF-α, thereby promote repairing the intestinal mucosal barrier function damage.

The Auxiliary Diagnostic Value of Serum Adenosine Deaminase in Acute Leukemia at Clinical Test / 中国实验血液学杂志

OBJECTIVE@#To investigate the auxiliary diagnostic value of serum adenosine deaminase (ADA) in acute leukemia (AL) at clinical test.@*METHODS@#123 AL patients hospitalized in Zhejiang hospital from November 2018 to March 2020 were enrolled as the observation group, and 98 healthy people in the same period were randomly enrolled as the control group. AL patients were divided into two groups: 77 acute myeloid leukemia (AML) patients for AML group and 46 acute lymphoblastic leukemia (ALL) patients for ALL group. The levels of adenosine deaminase (ADA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH) and homocysteine (Hcy) in serum of the patients were detected, and the correlation of ADA with these items was analyzed. Receiver operating characteristic curve (ROC) was used to analyze the clinical diagnostic value of ADA, Yoden index was used to confirm the best cut-off point.@*RESULTS@#The serum ADA level in AL patients was significant higher than that in control group (P < 0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation of ADA with Hcy, ALT, AST, GGT, LDH in AML group (r = 0.47, r = 0.28, r = 0.37, r = 0.22, r = 0.55); and also there was a significant positive correlation of ADA with GGT in ALL group (r = 0.54). In AML group, the maximum area under ROC curve was 0.761 (P = 0.00), 95% confidence interval was 0.682-0.841, sensitivity was 54.50%, specificity was 98.90%, and the best cut-off point was 17.1 U/L. In ALL group, the maximum area under ROC curve was 0.785, 95% confidence interval was 0.694-0.877, sensitivity was 65.90%, specificity was 84.00%, and the best cut-off point was 13.45 U/L.@*CONCLUSION@#The detection of ADA in serum can be used as an auxiliary examination in patients with AL, which can provide a certain value for the diagnosis of the disease.

Effects of pelvic motion in third trimester on the elements and outcomes of childbirth in primipara / 中国实用护理杂志

Objective:To investigate the effect of pelvic motion in late pregnancy on the outcome of first trimester delivery.Methods:A total of 127 first-borns admitted to the midwifical clinic of Nanjing Maternal and Child Health Hospital from November 1, 2019 to March 10, 2020 were selected as the research objects, and they were divided into the walking group and the pelvic motion group according to the random number table method. In the end, 62 cases were included in the walking group and 65 cases in the pelvic motion group. The walking group did brisk walking in the third trimester. In the pelvic motion group, the motion in the third trimester consisted of the combined pelvic motion involving the two planes of the upright spine and the horizontal spine, and multiple peripelvic joints. The changes of fertility, birth canal and fetus before and after exercise were observed, and the outcomes of childbirth were compared between the two groups.Results:Indicators reflecting productivity: persistence time of "air bike" on the day before delivery was (27.12±7.73) seconds in the pelvic motion group and (20.56±6.60) seconds in the walking group, the difference was statistically significant ( t value was 5.12, P<0.01). The time of contractions after exercise before delivery was (269.38±123.70) seconds in the pelvic motion group and (591.29±201.82) seconds in the walking group, the difference was statistically significant ( t value was 10.89, P<0.01). The indicators reflecting the situation of the maternal birth canal were as follows: "sitting forward flexion level", pelvic motion group was (33.64±5.91) cm, walking group was (29.50±5.28) cm, the difference was statistically significant ( t value was 4.15, P<0.01). The cervical score during regular contractions was 8.01±1.69 in the pelvic motion group and 7.30±1.40 in the walking group, the difference was statistically significant( t value was 2.56, P<0.05). At the beginning of regular contractions, the proportion of fetal "occipital position" was 93.85% (61/65) in the pelvic motion group and 72.58%(45/62) in the walking group, the difference was statistically significant ( χ2 value was 10.41, P<0.01). The "no pain rate after exercise the day before delivery" was 72.31% (47/65) in the pelvic motion group and 29.03% (18/62) in the walking group, the difference was statistically significant ( χ2 value was 25.30, P<0.01). Time of the first labor was (395.84±165.24) min in the pelvic motion group and (574.35±152.23) min in the walking group, the difference was statistically significant ( t value was 6.32, P<0.01). The second stage of labor was (25.98±9.88) min in the pelvic motion group and (33.62±13.94) min in the walking group, the difference was statistically significant ( t value was 3.57, P<0.01). Conclusions:Pelvic motion in middle and late pregnancy can affect labor force, birth canal, fetus and other delivery factors, reduce movement pain and shorten the time of labor.

Effects of amniotic membrane transplantation combined with limbal stem cell autograft transplantation on ocular burns / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effects of amniotic membrane transplantation combined with limbal stem cell autograft transplantation on ocular surface repair time, repair rate and complications in patients with ocular burns. <p>METHODS: The clinical data of each 61 cases(61 eyes)of patients with ocular burns who were treated by limbal stem cell autograft transplantation(control group)or amniotic membrane transplantation combined with limbal stem cell autograft transplantation(observation group)were retrospectively analyzed. The postoperative ocular surface repair rate, repair time, and visual acuity and complications(symblepharon, corneal neovascularization, and keratohelcosis)at 12wk after operation were recorded in the two groups, and the levels of cytokines \〖vascular endothelial growth factor(VEGF), transforming growth factor-β1(TGF-β1), insulin-like growth factor-1(IGF-1)\〗 were compared between the two groups before operation and at 2wk after operation. <p>RESULTS: The postoperative ocular surface repair rate in observation group was higher than that in control group(<i>P</i><0.05)while the repair time was less than that in control group(<i>P</i><0.05). At 12wk after operation, the visual acuity in observation group was significantly better than that in control group(<i>P</i><0.05), and the total incidence rate of postoperative complications in observation group was significantly lower than that in control group(<i>P</i><0.05). At 2wk after operation, the levels of serum VEGF, TGF-β1 and IGF-1 in the two groups were significantly higher than those before operation(<i>P</i><0.05), and the levels in control group were higher than those in observation group(<i>P</i><0.05). <p>CONCLUSION: Amniotic membrane transplantation combined with limbal stem cell autograft transplantation has significant treatment effects on patients with ocular burns, and it can promote ocular surface repair, improve postoperative visual acuity, and can also regulate corneal neovascularization, and it also has positive significance in reducing the risk of postoperative complications.

Effects on the labor four elements of continuous epidural analgesia in labor / 中国实用护理杂志

Objective To explore the influence of continuous epidural analgesia in labor (hereinafter referred to as labor analgesia) to the labor four elements. Methods The study included 210 parturients with analgesia during labor, form cervix opens 2 cm, based on the parturients′choose. Observe the differences in the labor analgesia parturients, through the force of labor and birth canal, fetal and psychology. Results The uterine-work after analgesia showed a trend of rising first, then dropping, reduce abdominal pressure (t=46.78, P<0.01), and the contractive ability of musculus levator ani (t=20.99, P<0.01); Soften uterus cervix (t=3.59, P<0.01) and reduced the pelvic floor muscle convergent force (t=66.90, P<0.01); Decreased the fetal heart rate range (t=6.00, P<0.01), increased fetal heat deceleration times (t=6.85, P<0.01). The differences in the position of fetus was not statistically significant (χ2=6.00, P<0.01);Lower the pain score in the labor stage (t=60.25, P<0.01), increased the self-control score during the labor (t=24.30, P<0.01) and the satisfaction score during the labor, after analgesia (t=36.61, P<0.01). Conclusions The labor analgesia influenced labor elements, include the force of labor and birth canal, fetal and psychology, or promote or restrict or maintain.

Clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in treatment of traumatic glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To analyze the clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in the treatment of traumatic glaucoma, and to provide an effective treatment for improving the quality of life of patients with traumatic glaucoma. ·METHODS:Totally 90 patients (90 eyes) with traumatic glaucoma admitted in our hospital from January 2011 to July 2016 were divided into two groups (45 patients in each group) according to different treatment methods. The patients in the observation group underwent vitrectomy combined with cyclophotocoagulation under direct vision; the control group underwent vitrectomy combined with trans-scleral cyclophotocoagulation. We observed the effect of different treatment on visual acuity, intraocular pressure and complication of the two groups. ·RESULTS: The visual acuity of the observation group was significantly better than that of the control group after treatment (Z=-5.689, P<0.05). There was no significant difference on intraocular pressure between the two groups before treatment (P>0. 05). The change of decreased intraocular pressure in the observation group was less than that in the contral group after operation (P<0.05). After 1a follow-up,there was no significant difference on the change of decreased intraocular pressure between the two groups (P>0. 05). The complications of the two groups after treatment were vitreous hemorrhage, choroidal detachment, low intraocular pressure, increased intraocular pressure and other complications, but the complication rate of two groups were no different (x2=1.553,P=0.213).· CONCLUSION: Vitrectomycombinedwith cyclophotocoagulation under direct vision brings patients better visual acuity than that combined with trans-scleral cyclophotocoagulation.

Reaction kinetics on renal calculus dissolution by simulating test in vitro / 实用医学杂志

Objective To investigate the reaction kinetics between the stone-dissolving solution and the urinary stone in a model simulating the condition of a kidney for further clinical administration. Methods An artificial upper urinary tract was made by silica gel. Lactic acid prepared in the preliminary study was used to react with artificial stone in the model. The concentration of reaction product in the effluent was measured to identify the reaction velocity. Relationships between the efficiency and dissolution rate or stone surface was investigated. Results The highest utilization rate of dissolution was 100 ~ 150 mL/h. Dissolution efficiency is in positive rela-tion with stone surface. The efficiency correlates with the stone surface and infusion speed in the range of 50~400 mL/h. Conclusions Before dissolution treatment ,the stone should be shattered as deeply as possible to in-crease the surface of reaction. If possible ,the irrigating speed should be as high as possible to eliminate the stone sooner.

rs4715986 in DTNBP1 is associatedwith paranoid schizophrenia in Chinese Han population / 基础医学与临床

Objective To investigate association of the DTNBP1 gene polymorphisms with paranoid schizophrenia in Chinese Han populations by a two-stage study.Methods In the discovery stage, 11 SNPs in DTNBP1 were tested in 532 patients with paranoid schizophrenia and 488 controls by Sanger sequencing.In the validation sample (1 111 cases and 1 435 controls), Taqman genotyping method was used to genotype SNP rs4715986.Results In the discovery stage, SNP rs4715986 showed disease association (χ2=11.02, P<0.01) with paranoid schizophrenia for analysis of 532 patients and 488 controls;such an association survived a correction with 10 000 permutations (corrected P<0.05).In the validation sample (1 111 cases and 1 435 controls), we confirmed the genotypic association (χ2=9.292, P=0.01) of rs4715986 with paranoid schizophrenia.Conclusions The present results suggest that the DTNBP1 gene may be mainly involved in the development of paranoid schizophrenia in the Chinese Han population.

Significance and feasibility of distress screening as a routine comprehensive assessment in cancer clinical practice / 中国心理卫生杂志

This paper discusses cancer clinic benefit from distress screening through searching literatures within 15 years in the database of Pubmed,Medline,and CNKI,describes pros and cons of the frequently-used distress screening measurements in cancer clinical daily work,summarizes current situation,and makes suggestions about cancer distress screening in China

CT imaging features of ceftriaxone-associated urinary pseudolithiasis / 中华泌尿外科杂志

Objective To investigate the CT imaging features of urinary tract ceftriaxone-associated pseudolithiasis.Methods The CT imaging data of three patients with ceftriaxone-associated pseudolithiasis were collected from August,2008 to April,2012.Their data combined with related literatures were used to review CT imaging features of urinary tract pseudolithiasis.Those three patients,including 2 males and 1 female,were 9,21 and 55 years old,respectively.Ceftriaxone sodium was administrated to one patient due to appendicitis and the other two patients due to urinary tract infection.After ceftriaxone treatment,1 case began to have backache and abdominal pain on day 13,1 case presented backache with floc in the urine on day 2 and progressed to anuria,and the other one had cotton-like material in the urine on day 5.Urinary tract high density shadows were found in all patients by CT scan.The patient with anuria was treated with ureteroscopic lithotripsy and percutaneous nephrolithotomy.The other 2 cases were arranged to be followed up with CT scan.In those cases,the CT showed that the high density shadow in one patient disappeared 16 days after drug discontinuation.The high density shadow was significantly reduced 12 days after ceftriaxone withdrawal in the other one.However,no follow-up was performed afterwards.Results All the urinary tract ceftriaxone-associated pseudolithiasis presented the high density shadows on CT,with CT value 47-667 HU.The density of CT results is homogenic,except one ureteral stone.The pseudolithiasis,existed in kidney,ureter and bladder simultaneously,were found in two patients.And the other patient was found that the pseudolithiasis existed in both kidney and bladder.Two cases were accompanied with hydroureter and hydronephrosis and the other case were accompanied with cholecystolithiasis.The multiple renal pseudolithiasis was noticed in 2 cases,which exhibited the nodular shape.And one patient with hydronephrosis presented both sand-like and nodular stones.Ureteral pseudolithiasis was found in 1 case with 4 stones and the other one with 2 stones.In those pseudolithiasis,5 appeared column morphology and one showed nodular shape.The single nodular stone in bladder was found in one case.And the multiple bladder stones were found in 2 cases.Conclusions The CT imaging characters of urinary tract ceftriaxone-associated pseudolithiasis are high homogenic density shadows in multiple parts of bilateral urinary tracts.The ceftriaxone-associated pseudolithiasis is column shape in ureter and sand-like or nodular shape in kidney and bladder.

Guiding value of systemic vascular resistance index for vasoactive drugs used in septic shock patients / 重庆医学

Objective To analyze the influence of vasoactive drugs on hemodynamics in septic shock patients and to explore the guiding value of systemic vascular resistance index (SVRI) for the application of vasoactive drugs .Methods 21 cases of septic shock in ICU from March 2010 to April 2012 were retrospectively analyzed .The PiCCO monitor technique was applied to monitor the he-modynamic parameters including the cardiac index (CI) ,intrathoracic blood volume index (ITBI) ,systemic cenous resistance index (SVRI) and mean arterial pressure(MAP) ,once per 6-8 h .ITBI>850 mL/m2 was taken as the normal criterion .The data of 202 cases meeting the criterion were collected .These cases were divided into two groups according to whether MAP reach 65 mm Hg , the differences of hemodynamic parameters between the two groups were compared .The MAP≥65 mm Hg group was redivided in-to the group 1 ,2 and 3 according to SVRI .Blood characteristics of pressure ,CI and ITBI were compared among these 3 groups .Re-sults The ITBI value in the MAP<65 mm Hg group and the MAP≥65 mm Hg group was higher than the normal value .The CI and SVRI values in the MAP≥65 mm Hg group were higher than those in the MAP< 65 mm Hg group(P<0 .05) ,while the ITBI value had no difference between the two groups .The ITBI values in the three groups with different SVRI all were higher than the upper normal limit ,furthermore ,in the comparisons among 3 groups ,only comparison between the group 1 and the group 3 had sta-tistical difference(P= 0 .47) .When SVRI was lower ,the CI value was higher than the normal value .Along with the increase of SVRI ,MAP increased gradually ,and CI gradually declined .When SVRI was too high ,MAP had no significant increase ,but the CI value was lower than the lower limit .Conclusion The SVRI monitoring by PiCCO can help to guide the application of vasoactive drugs in septic shock patients ,lower SVRI means the declined vascular reaction and higher SVRI indicates the low cardiac function , moreover blood pressure can not be further enhanced by vascular excessive contraction .

Application of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation.</p><p><b>METHODS</b>Sixty rectal cancer patients undergoing selective low anterior resection were randomized into the trial group(n=30) and the control group(n=30). Patients in the trial group received clean liquid integral protein diet for 3 days before operation without mechanical bowel preparation. Patients in the control group received traditional diet and mechanical bowel preparation. The intraoperative and postoperative clinical data, the quality of bowel preparation, postoperative complications, and nutritional parameters were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in clinicopathological characteristics between the two groups before operation. The operative time, blood loss, quality of bowel preparation as well as postoperative hospital stay were not significantly different(all P>0.05). While the time to first flatus [(2.53±0.91) d vs. (3.03±0.68) d] and semi-liquid diet intake[(3.95±0.83) d vs. (4.52±1.14) d] were significantly shorter in the trial group as compared with the control group(all P<0.05). There were no death and no significant difference in postoperative complications [16.7%(5/30) vs. 20.0%(6/30), P>0.05]. The levels of postoperative total protein, albumin, and prealbumin decreased significantly. Meanwhile, the levels of postoperative albumin[(36.2±2.5) g/L vs. (33.5±2.6) g/L, P<0.01] and prealbumin [(325.4±28.2) mg/L vs. (302.5±34.2) mg/L, P<0.01] in the trial group were significantly higher than those in the control group.</p><p><b>CONCLUSIONS</b>Preoperative enteral nutrition can replace the mechanical bowel preparation with better efficacy, and improve the postoperative nutritional status without increasing surgical risk in rectal cancer patients undergoing radical operation.</p>

Etiology of hand-foot-and-mouth disease seen in Nanjing in 2010 and molecular characteristics analysis of EV71 / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the etiological agent of hand-foot-and-mouth disease (HFMD), and to genetically characterize enterovirus 71 (EV71) isolated from clinical specimens of HFMD patients in Nanjing in 2010.</p><p><b>METHOD</b>Throat swab specimens were collected from 248 inpatients with HFMD in Nanjing Children's Hospital and then viral isolation was performed. Real-time PCR was used for detection of EV71, coxsackievirus A16 (Cox A16) and other enteroviruses from the positive isolates. Twenty EV71 strains from different clinical types of cases were selected for entire VP1 coding gene amplification and sequencing, finally a phylogenetic tree was constructed among the 20 EV71 strains and EV71 representative strains of known genotypes and subgenotypes.</p><p><b>RESULT</b>From the 248 throat swabs specimens, 110 EV71 strains, 28 Cox A16 strains, and 8 other enterovirus strains were isolated and the positive rate was 44.35%, 11.29%, 3.23%, respectively. Then nucleotide sequencing was performed on the 20 EV71 strains. There was little difference in the nucleotide and the amino acid sequences among the 20 EV71 strains, the homology was 95.51%-100% and 98.32%-100%, respectively. The phylogenetic tree showed that all the 20 EV71 strains belonged to C4 subgenotype.</p><p><b>CONCLUSION</b>EV71 was the main pathogen of HFMD in Nanjing in 2010 and all the analyzed isolates belonged to C4 serotype. No significant difference was found in sequence of VP1 region of EV71 isolated from different clinical types of cases.</p>

An Investigation and Analysis on Satisfaction of Pediatric Services in Guangdong Province / 中华医院管理杂志

Object Through performing the service satisfaction survey,to learn their interest claim and discover the service defects ,so as to provide advice and countermeasures.Method Using field survey methods and statistics analysis to study.Result The satisfaction of relatives of pediatric patients at the level of "relatively good" and "good" is about 60% both in medical treatment environment and equipment ,over 70% in medical treatment effect,doctor capacity,nursing capacity and overall assessment,but only 5.1% in medical expenses.Conclusion Relatives of pediatric patients have high satisfaction in treatment capability of medical staff,medical treatment effect as well as overall assessment ,normal satisfaction in medical environment and equipment,but lowest satisfaction in medical expenses,and the satisfaction in tertiary hospital is not high.Relatives in some districts demand much in some aspects,such as improving hospital environment,attaching importance to ward hygiene ,improving service attitude,and providing single ward ect.

Effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma.</p><p><b>METHODS</b>Forty-eight patients with middle or low thoracic esophageal carcinoma underwent Ivor-Lewis esophagectomy. The patients were divided into small incision group (n = 25) and conventional group (n = 23) according to the patients' will. Serum levels of acute phase proteins C reactive protein (CRP), haptoglobin (HPT), α₁-acid glycoprotein (α₁-AG), ceruloplasmin (CER), transferrin (TRF), β₂-microglobulin (β₂-MG), album protein (ALB), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were measured and compared on 1st day before operation, at 18 hours as well as 3rd and 7th day after operation.</p><p><b>RESULTS</b>There was no significant difference in all the acute phase proteins indicators and IL-6 between the small incision and conventional groups at each time points after operation (P > 0.05). In both groups the levels of CRP, α₁-AG and HPT were significantly higher after operation than before operation (P < 0.05). The levels of ALB and TRF were significantly lower after operation than before operation (P < 0.05). The levels of CER and β₂-MG were not significantly different during perioperative period (P > 0.05). The level of TNF-α was significantly higher in the small incision group than that in the conventional group at the 18 hours postoperationally (P < 0.05), and were not significantly different on the other time points between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Compared with conventional operation, the small incision Ivor-Lewis esophagectomy do not significantly alleviate the stress of the surgical trauma in patients. Unchanging the essence of operation, if one is trying to minimize the stress caused by surgery on patients, the key factor is not the size of incision. An effective approach should be found in other operation-related factors.</p>

On the role and effect of incentive mechanism in encouraging proactive reporting on adverse events in hospital / 中华医院管理杂志

Objective Discussion of the role/effect of an incentive mechanism in encouraging proactive reporting of adverse events in hospital.Methods Applying an incentive mechanism to encourage medical staff to report on adverse events found in their hospitals.Incentives in question include financial rewards.alleviation or cancellation of some penalties for medical defects.These measures were followed by a comparison between the number and types of proactive reporting on adverse events with those prior to such measures.in addition to typical case studies.Results Comparison of the figures during Jan.August,2007 and those during the sanqe period in 2008 after the incentive mechanism was in place found significant changes.For example,cases of proactive reporting rose from 34 to 176.Most significant changes were found in even types including medical malpractice.For medical disposal events,the number of events rose from 5 in 2007 to 10 in 2008;events in medical technical inspections from 0 to 24 cases;and that of patients identification from 2 to 14.These figures were followed by typical case analysis and improvements.Conclusion Such all incentive mechanism has significantly increased the number of proactive reporting on adverse events in hospitals,changing the types of such reporting to stand out malpractice related events,and enhancing the reporting to improve quality of care in hospitals.

Effect of orexin-A on recovery from ketamine anesthesia in aged rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of orexin-A on the recovery and cognitive function of aged rats after ketamine anesthesia.</p><p><b>METHODS</b>Fifty-five aged rats were divided randomly into control group, model control group, 1 nmol/L Orexin-A group, and 4 nmol/L Orexin-A group. In the latter 3 groups, the rats received an intraperitoneal injection of ketamine at 100 mg/kg, and normal saline was injected in the control group. Ten minutes after the injections, the rats received intraventricular injections of artificial cerebrospinal fluid (control and model control group) or of 10 microl 1 or 4 nmol/L Orexin-A as indicated. The behavioral changes of the rats were assessed by the duration of loss of righting reflex (LORR). Electroencephalogram (EEG) recordings were used to evaluate the changes in rat brain activity by comparison of the percent of sigma wave in EEG before and after the intraventricular injections. Morris water maze was used to test the learning and spatial localization abilities of the rats.</p><p><b>RESULTS</b>Ketamine resulted in obvious impairment of learning and memory abilities of the aged rats. Orexin-A at 4 nmol/L induced significant decrease in the duration of LORR and marked reduction of sigma activities in anesthetic rats (P<0.05), and obviously improved the learning and spatial localization abilities of the rats after anesthesia (P<0.05).</p><p><b>CONCLUSION</b>Orexin-A can promote the recovery and improve the cognitive function of aged rats after ketamine anesthesia.</p>

Nonoperative management of blunt splenic injury / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the monitoring and therapeutic methods of nonoperative management of blunt splenic injury.</p><p><b>METHODS</b>Eighty-two cases with nonoperative management of 95 patients of blunt splenic injury from September 2005 to April 2008 were analyzed retrospectively. Percutaneous peritoneal drainage was applied to 75 cases, and auto-blood transfusion was applied to 38 cases. Eighty-two cases were followed up from 3 weeks to 8 months.</p><p><b>RESULTS</b>Eighty-two patients with nonoperative management were treated successfully, including 34 cases classified as grade III to IV, 6 cases over 55-years-old, 14 cases with severe multiple injury (ISS > or = 16) and 37 cases whose drained peritoneal blood volume were over 500 ml. The drained peritoneal blood volume was 30 to 2400 ml. The total volume of auto-blood transfusion was 22 300 ml and the average volume was 613 ml. All cases were followed up without delayed hematocele or peritoneal infection.</p><p><b>CONCLUSIONS</b>Most hemodynamically stable patients with blunt splenic injury can be healed with nonoperative management. The treatments including percutaneous peritoneal drainage and transfusion of auto-blood can significantly increase the performance rate and the achievement ratio of nonoperative management of blunt splenic injury.</p>

Human Cytomegalovirus UL143 Gene Polymorphisms in Low-Passage Clinical Isolates in Guangzhou / 热带医学杂志

Objective To investigate the polymorphism of human cytomegalovius UL143 gene of low passage clinical isolates in Guangzhou,China.Method PCR was performed to amplify the entire HCMV ULl43 gene region of 3 clinical isolates,which had been proven by multiplex PCR.The amplification products were cloned into pMD18-T-Vector and subjected to sequencing.The result of DNA sequences were analyzed together with the one of published homologous sequences in GenBank from 14 clinical isolates.Result There were several stop codons in UL143 gene due to a base deletion in open reading frame (ORF) of D3 isolate,which could lead to produce non-functional protein.UL143 ORF of Toledo isolate consisted of 279 nueleotides,encoding a protein with 92 amino acids.UL143 ORFs of other isolates consisted of 252 nueleotides,encoding a protein with 83 amino acids.The DNA sequences were quite conserved and all the variations were base substitution.The amino acid sequences of different isolates were highly conserved.with variation of 1.2%-2.4%.There were no additional or deleted sites of post translational modification of UL143 protein in all clinical isolates except Toledo isolate.There were some differences in the secondary structure among different isolates.The isoelectric point of UL143 protein of all clinical isolates except Toledo isolate was 8.75.Conclusion All DNA and deduced amino acid sequences of UL143 gene shared great similarity among HCMV clinical strains regardless of their polymorphism.