Bile duct ligation differently regulates protein expressions of organic cation transporters in intestine, liver and kidney of rats through activation of farnesoid X receptor by cholate and bilirubin

Body is equipped with organic cation transporters (OCTs). These OCTs mediate drug transport and are also involved in some disease process. We aimed to investigate whether liver failure alters intestinal, hepatic and renal Oct expressions using bile duct ligation (BDL) rats. Pharmacokinetic analysis demonstrates that BDL decreases plasma metformin exposure, associated with decreased intestinal absorption and increased urinary excretion. Western blot shows that BDL significantly downregulates intestinal Oct2 and hepatic Oct1 but upregulates renal and hepatic Oct2. In vitro cell experiments show that chenodeoxycholic acid (CDCA), bilirubin and farnesoid X receptor (FXR) agonist GW4064 increase OCT2/Oct2 but decrease OCT1/Oct1, which are remarkably attenuated by glycine-β-muricholic acid and silencing FXR. Significantly lowered intestinal CDCA and increased plasma bilirubin levels contribute to different Octs regulation by BDL, which are confirmed using CDCA-treated and bilirubin-treated rats. A disease-based physiologically based pharmacokinetic model characterizing intestinal, hepatic and renal Octs was successfully developed to predict metformin pharmacokinetics in rats. In conclusion, BDL remarkably downregulates expressions of intestinal Oct2 and hepatic Oct1 protein while upregulates expressions of renal and hepatic Oct2 protein in rats, finally, decreasing plasma exposure and impairing hypoglycemic effects of metformin. BDL differently regulates Oct expressions via Fxr activation by CDCA and bilirubin.

Preoperative Nomogram prediction model for lymph node metastasis in patients with renal cell carcinoma / 中华泌尿外科杂志

Objective:To identify preoperative clinical predictors of positive lymph nodes in patients with renal cell carcinoma (RCC)and provide a preoperative predictive model.Methods:The data of 173 RCC patients who underwent either retroperitoneal lymph node dissection or biopsy at a single institution from January 2016 to December 2020 were retrospectively analyzed. There were 109 males and 64 females, with an average age of (53.29±13.58) years, median tumor diameter of 70 (23-150) mm, 68 patients with local symptoms, 24 patients with systemic symptoms, and 56 patients with ECOG score ≥1. There were 96 patients with tumor pseudocapsule, 23 patients with renal vein or inferior vena cava tumor thrombus, 114 patients in stage T 1-2, 59 patients in stage T 3-4, 22 patients with distant metastasis and 88 patients with lymph node metastasis by preoperative imaging examination. Univariate analysis was performed by Mann-Whitney U test or Chi-square test, and multivariate logistic regression analysis was used to determine preoperative predictors of pathologic lymph node positivity. The significant variables were then included in a novel Nomogram to predict the probability of lymph node invasion.C-index and Bootstrap self-sampling methods were used to evaluate the discrimination and consistency of the model. Results:Of the 173 patients, 49(28.32%)and 124(71.68%)had pN 1 and pN 0 disease, respectively. Among 88 patients with suspected lymph node involvement (cN 1) assessed by preoperative imaging, only 47.73%(42/88) were confirmed to be pathologically positive. However, 8.24% (7/85) of the 85 patients with negative lymph nodes (cN 0) assessed by preoperative imaging were pathologically positive. Age, ECOG score, symptoms at presentation, tumor pseudocapsule, metastasis at diagnosis, clinical tumor stage, clinical nodal status, clinical nodal size, D-dimer, lactate dehydrogenase, microscopic hematuria were significant in the univariate analysis ( P<0.05). On multivariable analyses, the most informative independent predictors were age, clinical tumor stage, clinical nodal status, clinical nodal size and microscopic hematuria ( P<0.05). A Nomogram with good performance was developed to predict the probability of lymph node metastasis. The C-index of the model was 0.954, the calibration curve of forecasting curve with the ideal curve fit was good, indicating that the model has a good consistency. Conclusions:Younger age, microscopic hematuria, suspected lymph node involvement in imaging, larger lymph node diameter and higher T stage were independent risk factors for renal cell carcinoma with lymph node metastasis. The Nomogram based on the above factors has good identification and calibration ability, which can help predict the probability of lymph node metastasis of renal cell carcinoma before surgery.

The individual surgical protocol of transurethral en bloc resection of bladder tumor based on VI-RADS and preliminary experience / 中华泌尿外科杂志

Objective:To summarize our preliminary experience of the individual transurethral en bloc resection of bladder tumor (ERBT) based on vesical imaging-reporting and data system (VI-RADS).Methods:The clinical data of 32 bladder cancer patients admitted from January 2019 to October 2019 were retrospectively analyzed, including 26 males and 6 females. Among them, there were 27, 5, 26 and 6 patients who had primary, recurrent, single or mutiple blader tumors, respectively. And the median number of bladder tumor was 1(1-3) and the mean diameter was 2(0.6-4.5)cm.The patients were aged 37 to 82 years, with a median age of 63 years. All patients underwent multi-parameter magnetic resonance imaging (mpMRI) before surgery and acquired a VI-RADS score. Among the 32 patients, there were 8, 17, 2, 5, and 0 patients in the VI-RADS score category 1, 2, 3, 4, and 5, respectively. Based on the VI-RADS score and tumor size, morphology and number provided by the mpMRI, the urologists classified the tumor types into type 1, 2a, 2b, 2c, 3a, 3b, 3c, 4a, 4b or 5, and designed the surgical protocol for each type including the resection plan, boundary and depth. There were 8, 6, 7, 4, 0, 1, 1, 3, 2 and 0 patients in each type, respectively. The tumor types were further confirmed during the operation, and the operation was completed according to the surgical plans for different tumor types.Patients received intravesical therapy of gemcitabine within 24 hours after surgery.Results:All operations were successfully completed and none was converted to the traditional transurethral resection of the bladder tumor. The operation time was 5 to 35 minutes with a median time of 15 minutes. Tumor specimens from all patients contained the muscularis propria. Among the patients with scores 1, 2, 3 and 4, there were 8, 16, 1 and 0 patients diagnosed with non-muscle invasive bladder cancer (NMIBC), respectively. All the patients with NMIBC had negative basal resection margins and 6 out 7 muscle invasive bladder cancer (MIBC) patients had negative resection margins. There were no intraoperative complications such as bladder perforation and obturator reflex. Four patients experienced obvious postoperative bladder irritation and relieved after symptomatic treatment or removing catheter. Twelve patients received second resections, including 10 NMIBC patients and 2 MIBC patients. No residual tumor was found in the re-resected specimens. There were 9 and 12 NMIBC patients received regular intravesical therapy of gemcitabine or BCG, respectively. Among the 7 MIBC patients, 5 received radical cystectomy and two received bladder-preserving treatment including second resection, adjuvant chemotherapy and radiotherapy. The follow-up period was 3-12 months, with a median of 6 months. One NMIBC patient relapsed at 9th months after surgery and underwent ERBT.Conclusions:The personalized ERBT based on VI-RADS is safe and feasible, and can achieve negative margins in all NMIBC and some MIBC without severe complications.

Predicting the risk of muscle-invasive bladder cancer using vesical imaging-reporting and data system / 中华泌尿外科杂志

Objective To evaluate the accuracy and clinical significance of the vesical imagingreporting and data system (Ⅵ-RADS) in predicting muscle-invasive bladder cancer (MIBC).Methods The data of 59 bladder cancer patients who underwent multiparametric magnetic resonance imaging and surgery between 2014 March and 2019 May were retrospectively analyzed,which includes 51 males and 8 females,aged 36-82 years old,with a median age of 62 years old.According to the scoring methods specified by Ⅵ-RADS,radiologists read and scored all mpMRIs including T2-weighted imaging (T2WI),diffusion-weighted imaging(DWI),and dynamic contrast enhancement MRI(DCE-MRI) of all the included patients.And then the Ⅵ-RADS were compared with pathological diagnosis.Proportions of MIBC in each score category were calculated,and ROC curve was plotted and the area under the curve (AUC) was estimated to assess the sensitivity and specificity of Ⅵ-RADS in diagnosing MIBC.Results The number of patients in Ⅵ-RADS score category 1 to 5 were 12,28,2,15 and 2,respectively.And there were 0,2 (7.4％),1 (50.0％),13 (81.3 ％),2 (100.0％) MIBC patients in each score category,respectively.When Ⅵ-RADS ≥3 was used to define MIBC,it came to the largest Youden's Index(0.7913),with an AUC of 0.924.And the sensitivity and specificity were 88.9％ and 90.2％,respectively.Conclusions Ⅵ-RADS has high accuracy in predicting MIBC,and it is worthy of application and verification in further clinical practice.The urologists should be highly alert to the existence of MIBC when Ⅵ-RADS ≥3.

Efficacy of dexmedetomidine in preventing agitation during recovery from general anesthesia in patients undergoing uvulopalatopharyngoplasty / 中华麻醉学杂志

Objective To evaluate the efficacy of dexmedetomidine in preventing agitation during recovery from general anesthesia in patients undergoing uvulopalatopharyngoplasty (UPPP).Methods Sixty adults patients with obstructive sleep apnea syndrome,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,aged 24-62 yr,with body mass index of 24-37 kg/m2,undergoing elective UPPP,were divided into dexmedetomidine group (group D) and conventional group (group C) using a random number table method,with 30 patients in each group.Dexmedetomidine was infused in a loading dose of 0.8 μg/kg over 10 min starting from 10 min before anesthesia induction,followed by a continuous infusion of 0.4 μg · kg-1 · h-1 for 30 min in group D,while the equal volume of normal saline was given instead of dexmedetomidine in group C.Anesthesia was induced and maintained by target-controlled infusion of propofol and remifentanil,and bispectral index value was maintained at 40-60 during surgery.Patients were extubated after they restored spontaneous breathing completely,opened eyes on verbal command and responded to verbal command,and then the patients were transferred to the recovery room,and oxygen was inhaled by mask.The emergence time,extubation time and development of agitation were recorded.Verbal rating scale was used to assess pain at 30 min after patients were transferred to the recovery room.Results Compared with group C,the incidence of agitation was significantly decreased,pain was reduced,and the emergence time was prolonged in group D (P＜0.05).There was no significant difference in extubation time between two groups (P＞0.05).Conclusion Dexmedetomidine can effectively prevent the occurrence of agitation during recovery from general anesthesia in patients undergoing UPPP.

Effects of different anesthetic methods on postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy / 中华麻醉学杂志

Objective To evaluate the effects of different anesthetic methods on postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy.Methods Fifty-four patients of both sexes,aged 18-64 yr,with body mass index of 20-28 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective video-assisted thoracoscopic thymectomy,were allocated into 2 groups (n =27 each) using a random number table method:sevoflurane-based anesthesia group (group S) and propofol-based anesthesia group (group P).After routine anesthesia induction in two groups,anesthesia was maintained by inhaling sevoflurane and target-controlled infusion of remifentanil in group S and by target-controlled infusion of propofol and remifentanil in group P.Heart rate and mean arterial pressure were recorded before operation and at 5 and 10 min after extubation (T1.2).The intensity of pain at T2 and visual analog scale (VAS) score and consumption of morphine at 1,2,4,24 and 48 h after operation (T3-7) were recorded.The pressing times of analgesia pump,requirement for rescue analgesia and development of nausea and vomiting were recorded at T7.Results There were no significant differences in heart rate or mean arterial pressure at each time point between two groups (P＞0.05).Compared with group S,the intensity of pain was significantly alleviated at T2,and VAS scores and morphine consumption were decreased at T3,4 in group P (P＜0.05).There were no significant differences between group P and group S in VAS scores or consumption of morphine at T5-7,or pressing times of analgesia pump,requirement for rescue analgesia or incidence of nausea and vomiting at T7 (P＞0.05).Conclusion Propofol-based anesthesia provides better efficacy in alleviating postoperative acute pain in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy.

Effects of TLR4 knockout on immune cells and adipokines in mouse visceral adipose tissue / 中国免疫学杂志

Objective:To investigate the effects of TLR4 knockout on immune cells and adipokines in mouse visceral adipose tissue.Methods: Cells were isolated from the spleen and epididymal adipose tissue of 20-week-old male wild type mice C57BL/6 and TLR4-/-.The expression of F4/80,CD11b,CD11c,CD3,CD4 and CD8 in these cells were analyzed by flow cytometry.The expression of IL-6,HMGB1,TNF-α,adiponectin and resistin in epididymal adipose tissue were detected by qPCR.Results: Compared with wild type C57BL/6 mice,the percentage of M1 macrophage which marked F4/80+CD11b+CD11c+ in spleen and epididymal adipose tissue of TLR4-/-mice increased(P<0.05) greatly,while that of M2 macrophage which marked F4/80+CD11b+CD11c-was decreased(P<0.05)significantly.This trend was more remarkable in epididymal adipose tissue than in spleen(P<0.05).In epididymal adipose tissue,the percentage of CD4+T cells decreased but that of CD8+T cells increased in TLR4-/-mice.Moreover,the high-level expressions of IL-6,HMGB1,resistin were found in epididymal adipose tissue of TLR4-/-mice.However,the expressions of TNF-α and adiponectin decreased obviously.Conclusion: TLR4 knock-out could lead to a disorder in adipokine and immune cells in visceral adipose tissue.

Efficacy of laryngeal mask airway Guardian for airway management in patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy / 中华麻醉学杂志

Objective To evaluate the efficacy of laryngeal mask airway (LMA) Guardian for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients of both sexes,aged 26-64 yr,weighing 48-95 kg,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with Mallampati grade Ⅰ-Ⅲ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were divided into group Ⅰ and group Ⅱ (n =30 each) using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA Guardian.In group],the nasogastric tube was inserted through the nostril before operation,and after successful LMA Guardian placement,another nasogastric tube was inserted through the drain tube of LMA Guardian.The hemodynamic parameters,SpO2,end-tidal pressure of carbon dioxide and peak airway pressure (Ppeak) were monitored during operation.The fiberoptic laryngoscopy scores were assessed after successful LMA placement,and the nasogastric tube displacement was recorded.The LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,occurrence of air leakage of LMA and nasogastric tube drainage were recorded.The bloodstains and gastroesophageal reflux were observed after removal of the LMA.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after operation.Results The hemodynamics was stable,the SpO2 and Ppeak were within the normal range during operation,and Ppeak was lower than airway sealing pressure in the two groups (P＞0.05),and there was no significant difference between the two groups.There was no significant difference between the two groups in the LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,score for exposure of oropharynx,development of adverse reactions in the oropharynx,consumption of anesthetics,development of bloodstains within the body of LMA and gastroesophageal reflux,and pH values at the tip of LMA and on the dorsal and ventral sides of the body of LMA (P＞0.05).Nasogastric tube drainage:the rate of nasogastric tube drainage through the LMA Guardian was 67％ in group Ⅰ;the rate of nasogastric tube drainage through the nostril was 40％,and the rate of nasogastric tube drainage though the LMA Guardian was 50％ in group Ⅱ.No nasogastric tube displacement was found after operation in group Ⅱ.Conclusion For the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy,insertion of LMA Guardian is easy,and LMA Guardian can assure good airway sealing and adequate ventilation and can be safely and effectively used for airway management in this type of patients.

Effect of wire-reinforced polyurethane epidural catheters on success rate of epidural catheterization in patients undergoing caesarean section / 中华麻醉学杂志

Objective To evaluate the effect of wire-reinforced polyurethane epidural catheters on the success rate of epidural catheterization in the patients undergoing caesarean section.Methods A total of 182 pregnant patients,aged 25-43 yr,with body height of 145-178 cm,weighing 51-100 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were divided into 2 groups using a random number table:polyvinyl chloride epidural catheter group (group Ⅰ,n =94) and wire-reinfnrced polyurethane epidural catheter group (group 11,n=88).Spinal or epidural puncture was performed at L2,3 or L3,4 interspace,and the corresponding epidural catheter was inserted in each group aficr succcssful puncturc.Thc dcvclopment of difficult insertion,intravascular catheter insertion or paresthesia during puncture or insertion was defined as a failure of epidural catheterization.The occurrence of failed epidural catheterization was recorded.Results The failure rate of epidural catheterization was significantly lower in group 1Ⅱ than in gronp Ⅰ (P＜0.05).Conclusion Wire-reinforced polyurethane epidural catheters can raise the success rate of epidural catheterization in the patients undergoing caesarean section.

Relationship between neuromuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis / 中华麻醉学杂志

Objective To determine the relationship between neuronuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis (MG).Methods Sixty-five patients of both sexes with MG,aged 20-75 yr,weighing 53-92 kg,with body height of 155-185 cm,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective videoassisted thoracoscopic thymectomy,were enrolled in the study.Among the 65 patients,there were 8 patients with ocular MG (type Ⅰ),19 patients with mild generalized MG (type]Ⅱ a),33 patients with subacute generalized MG (type Ⅱ b),2 patients with acute MG (type Ⅲ) and 3 patients with late severe MG (type Ⅳ).Neuromuscular monitoring was initiated when the patients lost consciousness after induction of anesthesia.Cisatracurium was administrated with the initial dose of 0.05 mg/kg,and if T1 depression was less than 95％ within 6 min,cisatracurium 0.015 mg/kg was intravenously injected until T1 depression was more than 95％.The patients were then tracheally intubated.The amount of cisatracurium consumed for intubation,onset time (from the beginning of cisatracurium injection to T1 depression ＞95％) and recovery time (recovery of T4/T1 to 25％ of control height) of neuromuscular block were recorded.T1 depression ＞ 95％ within 6 min after administration of 1-fold ED95 cistracuriun was defined as sensitivity to muscle relaxants.The requirement for cistracurium ＞ 1-fold ED95 when T1 depression ＞ 95％ was defined as insensitivity to muscle relaxants.The proportion of sensitivity/insensitivity was calculated.Results There was no significant difference in the amount of cisatracurium consumed for intubation and onset time and recovery time of neuromuscular block between patients with type Ⅰ and those with type Ⅱ a (P＞0.05).Compared with patients with type Ⅰ and type]Ⅱ a,the amount of cisatracurium consumed for intubation was significantly decreased,the proportion of sensitivity/insensitivity was increased,the onset time was shortened,and the recovery time was prolonged in patients with type Ⅱ b (P＜0.05).Conclusion With the severity of MG,the consumption of cisatracurium is gradually decreased when used for tracheal intubation during anesthesia induction,and the sensitivity is gradually increased in the patients with MG.

Feasibility and accuracy of quantification of fat content using iterative decomposition of water and fat with asymmetry and least squares estimation-quantitative fat imaging：a phantom study / 中华放射学杂志

Objective To validate the feasibility and accuracy of iterative decomposition of water and fat with asymmetry and least squares estimation-quantitative fat imaging (IDEAL-IQ) in fat quantification using fat-water model. Methods A homogeneous fat-water mixture model consisting of various known fat-fractions were described, and the fat fraction was 0.00, 0.01, 0.02, 0.04, 0.06, 0.08, 0.10, 0.14, 0.18, 0.22, 0.26, 0.30 g/ml respectively. A water-vaseline separated model was also described. IDEAL-IQ was performed. Thin slices were acquired for fat-water mixture model and repeated 3 days later. Nineteen slices of 14 mm-thick parallel to the water-vaseline boundary in 1 mm steps from vaseline to water were acquired. The fat-fractions in 11 slices of fat-water mixture model were measured on FatFrac images. Accuracy was assessed through single sample t test or Kolmogorov-Sirmov test. Measured fat-fractions of the same known fat-fraction were assessed through independent samples t test between two scan times. Linear regression was used to assess the relationship between known fat-fractions and measured fat-fractions. Slices containing the water-vaseline boundary were measured with ROI in the middle of the FatFrac images. The relationship between measured fat-fractions and locations of scanning was exploded using curve fitting. Results (1) Fat-water mixture model: no significant difference(P>0.05) was found between measured fat-fractions and known fat-fractions when it was 0.00, 0.02, 0.06 and 0.08 g/ml with the measured fat-fractions 0.60%, (2.30 ± 0.60)%, (5.76 ± 1.40)%, (7.62 ± 1.40)% respectively for the first time. No significant difference(P>0.05) was found between measured fat-fractions and known fat-fractions when it was 0.00, 0.02, 0.10 g/ml with the measured fat-fractions 0.04%, (2.32 ± 0.60)%, (9.41 ± 1.00)%respectively for the second time. Measured fat-fraction was inlinear relation with known fat-fraction:Y=0.898X+0.224, r2=0.993, P<0.01, F=36 129.548.(2) Water-vaseline separated model: measured fat-fraction increased as scanning location changed, Y=0.045X2-0.499X-4.474, r2=0.978, P<0.05, F=350.623.Conclusions IDEAL-IQ can be used to quantify fat content with good repeatability and can accurately assess the actual fat content from the linearrelationship.

Clinical manifestation of preeclampsia complicated with placental abruption and its treatment measure / 中国基层医药

Objective To study the clinical manifestation of preeclampsia complicated with placental abrup-tion and its treatment measures.Methods 160 patients with placenta abruption were selected,and the patients with preeclampsia complicated with placental abruption were selected as the study group(70 cases),and the patients with non preeclampsia complicated with placental abruption were selected as the control group(90 cases).The clinical manifestations,infant outcome and treatment measures of the two groups were compared.Results When the disease attack of the study group often accompanied with vaginal bleeding,but few had symptoms of abdominal pain,the main symptoms of the control group was vaginal bleeding and abdominal pain.The occurrence rate of abdominal pain of the two groups had statistically significant difference(4.3%vs 92.2%,χ2 =11.032,P0.05);The incidence of neonatal asphyxia of the two groups had no significant difference(56.6%vs 55.6%,P>0.05);The perinatal mortality of the two groups had sta-tistically significant difference(31.7%vs 11.1%,P0.05).Conclusion The clinical manifestation of preeclampsia was not typical,with a greater harm to the fetus and perinatal infant,operation to termination of pregnancy is the main method for treatment of preeclamp-sia complicated with placenta abruption.

Adenoid cystic carcinoma of the tracheobronchial tree:MSCT features / 中国肿瘤临床

Objective:This study is to improves the understanding of adenoid cystic carcinoma (ACC) of the tracheobronchial tree by observing the multi-slice cornputed tomography (MSCT) features. Methods:The MSCT features of 19 cases with primary tra-cheobronchial ACC confirmed by histopathology were retrospectively analyzed. Results:Among the 19 cases, lesions were located in the trachea in seven cases, in the segmental and above segmental bronchi in 10 cases, in the peripheral lung in two cases. Intra-and ex-traluminal growth were observed in 15 cases (79%), whereas broad-based intraluminal lesions were exhibited in two cases (11%). Among the seven cases of tracheal ACC, the CT scans for five cases showed a notable tendency toward submucosal extension. Two cas-es manifested as a diffuse or circumferential wall thickening of the trachea, and the other three cases presented homogeneous mass fill-ing of the trachea with wall thickening. The 10 cases with bronchial ACC were manifested as intra-and extraluminal growth. Eight cas-es presented homogeneous polypoid growth toward the adjacent lumen, and seven cases presented extraluminal parts that were larger than the intraluminal parts. Among 13 contrast-enhanced examinations, three cases were without enhancement, five cases were slightly enhanced, four cases were moderately enhanced, and one case was highly enhanced. Conclusion:MSCT performances of ACC of the tracheo-bronchial tree possessed certain characteristics, such as broad-based mass, intra- and extraluminal growth, and diffuse wall thickening. CT can diagnose tumor malignancy, but the definitive diagnosis for ACC should depend on pathology.

Logistic regression analysis of risk factors of postpartum hemorrhage of cesarean section / 中国基层医药

Objective To investigate the risk actors of postpartum hemorrhage of cesarean section,in order to provide the basis for the prevention of hemorrhage after cesarean section.Methods A case-control study was conducted in 100 cases with postpartum hemorrhage of cesarean section and 200 cases without bleeding of cesarean section.The clinical data were compared and analyzed.The single factor and multiple factors of the Logistic analysis was used to analyze the risk factors of postpartum hemorrhage of cesarean section.Results Fetal macrosomia (OR =3.678,95％ CI:1.456-5.345),placenta adhesion (OR =4.264,95％ CI:1.556-5.646),placenta praevia (OR =2.754,95％ CI:1.754-5.456),multifetal pregnancy (OR =3.964,95％ CI:1.274-4.453) were the risk factors of postpartum hemorrhage after cesarean section.Conclusion Evaluation of the above risk factors before cesarean section was important for prevention of postpartum hemorrhage.

A cohort study on the association between gallstone, cholecystectomy and colorectal cancer in Gansu province inhabitants / 中华普通外科杂志

Objective To determine the association of gallstone,cholecystectomy and colorectal cancer.Methods From 2000 through 2007,a historical cohort study was carried out in the check analysis of the cumulative incidence of colorectal cancer of 3809 gallstone patients who had had cholecystectomies (cholecystectomy sub-group),1764 gallstone patients who had not had cholecystectomies(noncholecystectomy sub-group)and 8187 nongallstone patients(control group)were also included in the analysis of the incidence of colorectal cancer.Results(1)The cumulative incidence of colorectal cancer of the gall-stone group was 0.43 ％(24/5573)while that of the control group was 0.13 ％(11/8187)(x2 =11.879,P =0.001).(2)The cumulative incidence of colorectal cancer in cholecystectomy sub-group was 0.45％(17/3890)while that of the non-cholecystectomy sub-group was 0.40％(7/1764)(x2=0.069,P =0.793).(3)The cumulative incidence of colorectal cancer was 0.23％(8/3467)in gallstone patients with a conrse ＜ 15 years,while that was 0.76％(16/2106)when the course ≥ 15 years(x2 =8.550,P =0.003).(4)Serum triglyceride level elevated in 20.83％(5/24)colorectal cancer cases of gallstone group,however serum triglyceride level elevated only in 5.86％(325/5549)of gallstone group with non-colorectal cancer cases(x2 =9.621,P =0.002).(5)The incidence of colorectal cancer in gallstone group was not related to gender,age,overweight,hypertension,diabetes mellitus and dysfunction of liver(x2 =1.444,P =0.229;x2=7.833,P=0.251;x2 =1.151,P=0.283;x2 =0.797,P=0.372;x2 =0.939,P=0.332;x2 =2.103,P =0.147).(6)The ratio of rectal cancer,right colonic cancer,left colonic cancer and multifocal carcinoma were 41％(10/24),38％(9/24),17％(4/24)and4％(1/24),respectively.Conclusions Gallstone is a high risk factor of colorectal cancer irrespective of whether or not a cholecystectomy is carried out.Over fifteen-years course of gallstone and hypertriglyceridemia significantly increases the risk of the colorectal cancer in gallstone patients.The incidence of rectal cancer and right colonic cancer is more frequently seen in gallstone related colorectal cancer.

Changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery / 中国医师进修杂志

Objective To investigate the changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery. Methods Thirty ASA Ⅰ-Ⅱ patients scheduled for laparoscopic colorectal surgery were accepted general anesthesia and trachea cannula. Hemodynamic measurements, respiratory parameters and artery blood gas analysis were drawn at 5 min after intubating, 5 min, 30 min and 60 min after pneumoperitoneum, before the side-incisions were opened and the end of operations. Results The operation time was (216.1±39.1) min, pneumoperitoneum time was (117.3±11.5) min. Comparing to the data after pneumoperitoneum, there were differences among the parameters of circulating dynamics, but the values were acceptable, pH was decreasing with time, except 5 min after pneumoperitoneum, it was significantly decreased 30 min after pneumoperitoneum until the end of operations, compared with pre-intlation value (P<0.01), pH withdrawn a little at the end of the operations. The PETCO2 and PaCO2 at different times after pneumoperitaneum were significantly higher compared with pre-inflation value (P<0.05 or<0.01). They were increasing with the time of pneumoperitoneum, and withdrawn a little at the end of the operations. There was a good correlation between PETCO2 and PaCO2, although the correlation was worst after deflation. Conclusions The circulation dynamics are stable, the correlation of PETCO2 and PaCO2 is good during the laparoscopic colorectal surgery, PaCO2 may exceed the normal value after long-term of penumoperitoneum. It is necessary to monitor the blood gas analysis during such surgeries.

Curative effect and nursing for micro-penetration heating treating wound arms and legs fracture / 中国基层医药

Objective The observation of curative effect and nursing for micro-penetration heating treating wound arms and legs fracture after the operation. Methods 76 cases of the patients suffered from wound arms and legs fracture are divided into 38 cases as the observation group and 38 cases the comparison group at random. The comparison group is treated by normal method only and the observation group is started to be treated by micro-penetration heating treating device for the ray based on the normal method only the second day after operation. Results The observation group is superior to the comparison group in pain situation, wounded infection rate and coalescence time totally (P<0.05). Conclusion The micro-penetration heating treatment can relieve the pain of wound bone fracture to prevent from wounded infection, coalescence to shorten the time of patients' treatment in hospital so that it has a very consequence for it to relieve press from the psychology and finance.

Effect of fluid resuscitation on hemodynamics and oxygen in severe trauma patients / 中国综合临床

Objective To observe the effect of fluid resuscitation on hemodynamies and oxygen in severe trauma patients. Methods Parameters of hemodynamic and oxygen metabolism in different fluid volume resuscita-tion in 24 severe trauma patients who were injured on abdominal were measured. Results By fluid resuscitation, as the systolic blood pressure was raised from 80～90 mm Hg(1 mm Hg=0.133 kPa) to 100～120 mm Hg,cardiac in-dex rose from (2.0±0.5 ) L/(min·m2) to (3.2±0.6) L/(min·m2) (P<0.05), systemic vascular resistance index rose from (1857.6±750.2) dyn·s/(cm5·m2) to (3741.5±862.1) dyn·s,/(cm5·m2) significantly (P<0.05). Meanwhile, oxygen delivery index rose from (301.1±74.1) ml/(min·m2) to (554.1±80.0) mL/(min·m2) (P<0.05), and oxygen consumption index also rose (99.7±51.4) mL/( min·m2) to (147.2± 60.1) mL/(min·m2) remarkably (P<0.05), the rate of oxygen expenditure decreased from (33.1±9.1) % to (26.6±8.0) % significantly (P<0.05). Conclusion Large volume resuscitation maybe benefit to the improve-ment of hemodynamics and oxygen metabolism in the emergency resuscitation.