Relationship among perceived social support, bullying defender and depression symptoms in middle school students / 中国学校卫生

Objective@#To identify potential categories of perceived social support for middle school students and further analyze the association of different categories with bullying defender and depressive symptoms, so as to provide a reference for promoting protection for primary school bullying and reducing depression.@*Methods@#From September to November 2021, a total of 1 021 junior high school students and senior high school students from there middle schools in Liaoning Province by convenient whole group sampling method were taken as the object of the research. Students completed the Multidimensional Scale of Perceived Social Support (MSPSS), Participant Role Questionnaire (PRQ) and Self rating Depression Scale (SDS). Latent Profile Analysis, the R3STEP method and the DU3STEP method and Logistic regression analysis were used to analyze the data.@*Results@#Middle school students perceived social support was classified into four potential categories: low perceived social support group (8.03%, 82), perceived friendship support group(15.38%, 157), moderate perceived social support group (35.26%, 360) and high perceived social support group(41.33%, 422). Logistic regression analysis showed that girls and junior high school students had greater proportions in the perceived friendship support group( OR=0.65, 0.52, P <0.05). There were significant differences in bullying defender and depression symptom among middle school students among different potential categories of perceived social support ( χ 2=47.99, 48.80, P <0.01). The score of bullying defending the low perceived social support group was the lowest(33.75±0.82), but the highest in depressive symptoms(49.82±0.72).@*Conclusion@#There is heterogeneity in perceived social support among middle school students. By consciously improving the level of perceived social support for middle school students, families and schools can effectively promote bullying defender and reduce depressive symptoms.

Research progress on the characteristics and rapid diagnostic tools of early lung adenocarcinoma subtypes / 中国胸心血管外科临床杂志

@#Lung adenocarcinoma has become the most common type of lung cancer. According to the 2015 World Health Organization histological classification of lung cancer, invasive lung adenocarcinoma can be divided into 5 subtypes: lepidic, acinar, papillary, solid, and micropapillary. Relevant studies have shown that the local lobectomy or sublobectomy is sufficient for early lepidic predominant adenocarcinoma, while lobectomy should be recommended for tumors containing micropapillary and solid ingredients (≥5%). Currently, the percentage of micropapillary and solid components diagnosed by frozen pathological examination is 65.7%, and the accuracy of diagnosis is limited. Therefore, to improve the accuracy of diagnosis, it is necessary to seek new methods and techniques. This paper summarized the characteristics and rapid diagnosis tools of early lung adenocarcinoma subtypes.

A comparative study on the difference coefficients of DRG payment in various cities in Zhejiang province / 中华医院管理杂志

In order to compare the setting of difference coefficients in DRG point payment in different cities in Zhejiang province, the implementation rules of DRG point payment issued by 11 cities in Zhejiang province were comprehensively analyzed. It was found that the difference coefficients in different cities could be divided into three categories, including hospital coefficients alone, hospital coefficients and grade coefficients weighted, and weighted by hospital coefficients, grade coefficients, personal burden levels, case mix indexes, and head-to-time ratio. Its setting differences included four aspects: connotation composition, weight distribution, threshold value, and classification of medical institutions. The authors suggested that the adjustment cycle should be set scientifically to dynamically adjust the difference coefficient, and the scientific setting of the difference coefficient should be promoted through provincial coordination.

Prognostic index construction and analysis of immune infiltration combined with RNA binding protein and transcription factor in hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To comprehensively analyze the prognostic prediction value of RNA binding protein, transcription factor gene expression and immune infiltration in hepatocellular carcinoma (HCC).Methods:Common gene sets associated with RNA-binding proteins and transcription factors were screened in TCGA ( n=365) , GSE54236 ( n=78) and GSE14520 ( n=221) datasets. Univariate Cox regression was used for primary screening. The survival regression model was constructed by LASSO-Cox. And a complex index [CIRT=(score-min)/max] was calculated. According to the median of CIRT, the HCC patients were divided into CIRT high group ( n=182) and CIRT low group ( n=182). The differences of prognosis, immune infiltration between the two groups were analyzed. Results:Of 37 prognostically relevant RNA binding protein and transcription factor genes were identified. The prognosis prediction model based on seven selected genes was determined by stepwise regression. Patients in the CIRT high group exhibited a lower percentage of macrophages in M1 ( P=0.032), macrophages in M2 ( P=0.009), resting mast cell ( P<0.001), activated NK cells ( P=0.007), and resting memory CD4 + T cells ( P<0.001), while patients in the CIRT low group showed a lower level of resting dendritic cells ( P=0.048), macrophages in M0 ( P<0.001), neutrophils ( P=0.049), follicular helper T cells ( P=0.004) and regulatory T cells ( P=0.001). GSEA analysis has shown that CIRT high groups were highly enriched in cell cycle, DNA repair pathways in TCGA and GSE14520. In the TCGA cohort, the CIRT low group had better overall survival than the CIRT high group. Analysis of 5-year follow-up data in the TCGA cohort showed that CIRT had a good predictive value for long-term survival of patients with liver cancer (area under receiver operating characteristic curve was 0.71). Conclusion:A novel prognostic index and classifier based on RNA-binding protein expression, transcription factors and immune expression profiles were developed and cross-cohort validated. CIRT could be used as an independent predictor.

International experience and enlightenment of short-term payment for innovative medical technology under the DRG payment / 中华医院管理杂志

China has entered the task stage of comprehensive medical insurance payment reform, but there are problems restricting the development of innovative medical technology in the reform of diagnosis-related groups(DRG) payment system. The author introduced the international definition and scope of innovative medical technology, and summarized the preconditions and payment policy of short-term payment of innovative medical technology under the DRG payment system; And put forward suggestions in line with China′s actual situation, including clarifying the definition of innovative medical technology, setting access conditions for additional payment or actual payment, setting up special transition funds for high-value innovative drugs, clarifying the payment amount of innovative medical technology, and formulating payment strategies for innovative medical technology.

7SK truncation at 128-179 nt suppresses embryonic stem cell proliferation / 南方医科大学学报

OBJECTIVE@#To explore the role of small nuclear noncoding RNA 7SK in embryonic stem cell (ESCs) proliferation and the value of 7SK as a target for early diagnosis and treatment for primordial dwarfism (PD).@*METHODS@#ESC line R1 was transfected with the CRISPR/Cas9 system, and sequencing of the PCR product and glycerol gradient analysis were performed to identify novel 7SK deletion mutations. A lentivirus system was used to knock down cyclin-dependent kinase 9 (CDK9) in clones with 7SK deletion mutations, and the effect of CDK9 knockdown on the protein level of cell division cycle 6 (CDC6) was analyzed with Western blotting.@*RESULTS@#We identified a novel deletion mutation of 7SK at 128-179 nt in the ESCs, which resulted in deficiency of cell proliferation. 7SK truncation at 128-179 nt significantly reduced the protein expressions of La-related protein 7 (LARP7) and CDC6.@*CONCLUSIONS@#7SK truncation at 128-179 nt can significantly impair proliferation of ESCs by downregulating CDC6. 7SK is a key regulator of proliferation and mediates the growth of ESCs through a mechanism dependent on CDK9 activity, suggesting the value of 7SK truncation at 128-179 nt as a potential target for early diagnosis and treatment of PD.

Combined point of care nucleic acid and antibody testing for SARS-CoV-2: a prospective cohort study in suspected moderate to severe COVID-19 disease.

BackgroundRapid COVID-19 diagnosis in hospital is essential for patient management and identification of infectious patients to limit the potential for nosocomial transmission. The diagnosis of infection is complicated by 30-50% of COVID-19 hospital admissions with nose/throat swabs testing negative for SARS-CoV-2 nucleic acid, frequently after the first week of illness when SARS-CoV-2 antibody responses become detectable. We assessed the diagnostic accuracy of combined rapid antibody point of care (POC) and nucleic acid assays for suspected COVID-19 disease in the emergency department. MethodsWe developed (i) an in vitro neutralization assay using a lentivirus expressing a genome encoding luciferase and pseudotyped with spike (S) protein and (ii) an ELISA test to detect IgG antibodies to nucleocapsid (N) and S proteins from SARS-CoV-2. We tested two lateral flow rapid fingerprick tests with bands for IgG and IgM. We then prospectively recruited participants with suspected moderate to severe COVID-19 and tested for SARS-CoV-2 nucleic acid in a combined nasal/throat swab using the standard laboratory RT-PCR and a validated rapid POC nucleic acid amplification (NAAT) test. Additionally, serum collected at admission was retrospectively tested by in vitro neutralisation, ELISA and the candidate POC antibody tests. We evaluated the performance of the individual and combined rapid POC diagnostic tests against a composite reference standard of neutralisation and standard laboratory based RT-PCR. Results45 participants had specimens tested for nucleic acid in nose/throat swabs as well as stored sera for antibodies. Using the composite reference standard, prevalence of COVID-19 disease was 53.3% (24/45). Median age was 73.5 (IQR 54.0-86.5) years in those with COVID-19 disease by our reference standard and 63.0 (IQR 41.0-72.0) years in those without disease. The overall detection rate by rapid NAAT was 79.2% (95CI 57.8-92.9%), decreasing from 100% (95% CI 65.3-98.6%) in days 1-4 to 50.0% (95% CI 11.8-88.2) for days 9-28 post symptom onset. Correct identification of COVID-19 with combined rapid POC diagnostic tests was 100% (95CI 85.8-100%) with a false positive rate of 5.3-14.3%, driven by POC LFA antibody tests. ConclusionsCombined POC tests have the potential to transform our management of COVID-19, including inflammatory manifestations later in disease where nucleic acid test results are negative. A rapid combined approach will also aid recruitment into clinical trials and in prescribing therapeutics, particularly where potentially harmful immune modulators (including steroids) are used.

Rapid point of care nucleic acid testing for SARS-CoV-2 in hospitalised patients: a clinical trial and implementation study

BackgroundThere is urgent need for safe and efficient triage protocols for hospitalized COVID-19 suspects to appropriate isolation wards. A major barrier to timely discharge of patients from the emergency room and hospital is the turnaround time for many SARS-CoV-2 nucleic acid tests. We validated a point of care nucleic acid amplification based platform SAMBA II for diagnosis of COVID-19 and performed an implementation study to assess its impact on patient disposition at a major academic hospital. MethodsWe prospectively recruited COVID-19 suspects admitted to hospital (NCT04326387). In an initial pilot phase, individuals were tested using a nasal/throat swab with the SAMBA II SARS-CoV-2 rapid diagnostic platform in parallel with a combined nasal/throat swab for standard central laboratory RT-PCR testing. In the second implementation phase, we examined the utility of adding the SAMBA platform to routine care. In the pilot phase, we measured concordance and assay validity using the central laboratory as the reference standard and assessed assay turnaround time. In the implementation phase, we assessed 1) time to definitive bed placement from admission, 2) time spent on COVID-19 holding wards, 3) proportion of patients in isolation versus COVID negative areas following a test, comparing the implementation phase with the 10 days prior to implementation. ResultsIn phase I, 149 participants were included in the pilot. By central laboratory RT-PCR testing, 32 (21.5%) tested positive and 117 (78.5%). Sensitivity and specificity of the SAMBA assay compared to RT-PCR lab test were 96.9% (95% CI 0.838-0.999) and 99.1% (0.953-0.999), respectively. Median time to result was 2.6 hours (IQR 2.3 to 4.8) for SAMBA II SARS-CoV-2 test and 26.4 hours (IQR 21.4 to 31.4) for the standard lab RT-PCR test (p<0.001). In the first 10 days of the SAMBA implementation phase, we conducted 992 tests, with the majority (59.8%) used for hospital admission, and the remainder for pre-operative screening (11.3%), discharge planning (10%), in-hospital screening of new symptoms (9.7%). Comparing the pre-implementation (n=599) with the implementation phase, median time to definitive bed placement from admission was reduced from 23.4 hours (8.6-41.9) to 17.1 hours (9.0-28.8), P=0.02 in Cox analysis, adjusted for age, sex, comorbidities and clinical severity at presentation. Mean length of stay on a COVID-19 holding ward decreased from 58.5 hours to 29.9 hours (P<0.001). Use of single occupancy rooms amongst those tested fell from 30.8% before to 21.2% (P=0.03) and 11 hospital bay closures (on average 6 beds each) were avoided after implementation of the POC assay. ConclusionsThe SAMBA II SARS-CoV-2 rapid assay performed well compared to a centralized laboratory RT-PCR platform and demonstrated shorter time to result both in trial and real-world settings. It was also associated with faster time to definitive bed placement from the emergency room, greater availability of isolation rooms, avoidance of hospital bay closures, and greater movement of patients to COVID negative open "green" category wards. Rapid testing in hospitals has the potential to transform ability to deal with the COVID-19 epidemic.

Performance evaluation of the point-of-care SAMBA II SARS-CoV-2 Test for detection of SARS-CoV-2

Nucleic acid amplification for the detection of SARS-CoV-2 RNA in respiratory samples is the standard method for diagnosis. These tests are centralised and therefore turnaround times can be 2-5 days. Point-of-care testing with rapid turnaround times would allow more effective triage in settings where patient management and infection control decisions need to be made rapidly. Inclusivity and specificity of the SAMBA II SARS-CoV-2 assay was determined by in silico analyses of the primers and probes. Analytical and clinical sensitivity and specificity of the SAMBA II SARS-CoV-2 Test was evaluated for analytical sensitivity and specificity. Clinical performance was evaluated in residual clinical samples compared to the Public Health England reference tests. The limit of detection of the SAMBA II SARS-CoV-2 Test is 250 cp/mL and is specific for detection of 2 regions of the SARS-CoV-2 genome. The clinical sensitivity was evaluated in 172 clinical samples provided by the Clinical Microbiology and Public Health Laboratory, Addenbrookes Hospital, Cambridge (CMPHL), which showed a sensitivity of 98.9% (95% CI 94.03-99.97%), specificity of 100% (95% CI 95.55-100%), PPV of 100% and NPV of 98.78% (92.02-99.82%) compared to testing by CMPHLSAMBA detected 3 positive samples that were initially negative by PHE Test. The data shows that the SAMBA II SARS-CoV-2 Test performs equivalently to the centralised testing methods with a much quicker turnaround time. Point of care testing, such as SAMBA, should enable rapid patient management and effective implementation of infection control measures.

Parathyroid hormone 1-34 in the treatment of adjacent vertebral refracture after percutaneous kypho-plasty for thoracolumbar osteoporotic compression fracture / 中华创伤骨科杂志

Objective:To evaluate the efficacy of parathyroid hormone 1-34 (PTH1-34) in the treat-ment of adjacent vertebral refracture after percutaneous kyphoplasty (PKP) for thoracolumbar osteoporotic com-pression fracture (OVCF).Methods:A retrospective study was made of the 43 OVCF patients who had been admitted to Department of Orthopedics, Shanxi Bethune Hospital for adjacent vertebral refracture after PKP from January 2014 to June 2018.Of them, 22 were treated by secondary PKP (group A), 9 by secondary PKP+PTH1-34 (group B), and 12 by merely PTH1-34 (group C).The vertebral heights of anterior border and middle-line and sagittal kyphosis cobb angle on X-ray films at 6 months after operation, the bone mineral den-sities of the left hip at admission, 6 and 12 months after operation, and the Oswestry Dysfunction Index (ODI) and Visual Analog Scale (VAS) scores at admission, 3, 6 and 12 months after operation were recorded and compared.Results:The 3 groups were compatible because there were no significant differences between them in the preoperative general data ( P>0.05).Recurrent OVCF was found in 3 patients in group A but not in group B or C.The vertebral heights and kyphosis cobb angle at 6 months after operation were significantly improved compared to the preoperative values in groups A and B ( P<0.05) but not in group C.The T values of bone mineral density at 6 and 12 months after operation in group B and at 12 months after operation in group C were significantly improved compared to their preoperative ones ( P<0.05) but not in group A.The post-operative ODI and VAS scores were significantly improved compared to the scores at admission in all the 3 groups ( P<0.05). Conclusions:In the treatment of adjacent vertebral refracture after PKP for elderly OVCF patients, PTH1-34 can significantly improve their bone mineral density, prevent collapse of the injured vertebra and reduce re-fracture of adjacent vertebral body.A combination of PTH1-34 and PKP is an effective treatment of adjacent vertebral refracture after PKP because it can restore the vertebral heights and reduce kyphosis deformity.

Laparoscopic side-to-side jejunoileal anastomosis for the treatment of non-obese type 2 diabetes mellitus / 中华普通外科杂志

Objective:To analyze the feasibility, safety and clinical efficacy of laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes patients (BMI≤32.5 kg/m 2). Methods:The clinical data of 135 patients who underwent laparoscopic side-to-side jejunoileal anastomosis at our hospital from Jan 2018 to Oct 2018 were retrospectively analyzed. They were followed up for 12 months until the end of Oct 2019. SPSS software was used to compare patients′ fasting blood glucose, glycosylated hemoglobin, c-peptide, insulin, body weight, BMI with the values after 12 months of the surgery, and then evaluate factors affecting the prognosis.Results:135 patients successfully completed laparoscopic side-to-side jejunoileal anastomosis without conversion to open surgery. After 12 months of the operation, the patients′ fasting blood glucose was (5.80±0.18)mmol/L, glycosylated hemoglobin was 5.9%±0.4%, fasting c-peptide was(1.32±0.21) nmol/L, and fasting insulin was (42±54) mU/L ( t=10.654, 12.657, 11.214, 10.698, all P<0.05). The body weight was (72.4±9.9)kg, BMI was( 25.6±2.8)kg/m 2, and the difference was not statistically significant ( t=7.658, 6.958, P>0.05). In patients with preoperative glycosylated hemoglobin controlled below 8% and the duration of T2DM less than 10 years, the chances being cured was better than that of those with glycosylated hemoglobin>8% and the medical history >10 years. Conclusion:Laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes is effective, safe and reliable.

Accuracy Verification of Robot-assisted Mandibular Reconstruction Surgery / 中国医疗器械杂志

Mandible is an important bone of the head and neck. Mandibular defects not only affect patient's face, but also impede patient's daily functions, such as chewing, speech, and so on. Fibular transplantation for mandibular reconstruction is the common method, which requests high accuracy of bone positioning and posture adjustment. Therefore, a robotic system for mandibular reconstruction surgery with fibula flaps was designed to assist surgeons to hold and locate bones, and the model comparison experiments were conducted. The results showed that the robotic system can assist surgeons for mandibular reconstruction to improve quality of surgery.

Clinical symptoms of spinal tuberculosis in children and the effect of surgical treatment / 中国基层医药

Objective To analyze the clinical symptoms of spinal tuberculosis in children and the effect of surgical treatment.Methods From October 2012 to October 2017,60 cases of spinal tuberculosis admitted to Shanxi Dayi Hospital were selected,including 31 male children and 29 female children.The age of the children was (7.92 ±2.93)years old;4 children with cervical vertebra lesions,3 children with cervical thoracic junction lesions,23 children with thoracic vertebra lesions,28 children with lumbar vertebra lesions,and 2 children with lumbar sacral vertebra lesions.There were 27 children with neurological damage.Among them,2 children with Frankel classification of A,4 children with B,7 children with C,and 14 children with D.All children were treated by surgery,and standing full spine X-rays were taken before and after operation.The sagittal deviation distance and sagittal Cobb angle of the children's trunk were measured,and spinal fusion and fixation of all children were recorded.Results In 52 cases (86.67％),the main symptoms were pain or radiation pain,45 cases (75.00％) showed local palpable mass,and 7 cases (11.67％) had palpable paraspinal or abdominal mass.There were 37 cases (61.67％) with kyphosis and different degrees of spinal bulge,11 cases (18.33％) showed abnormal sensation and limb numbness.There were 11 cases (18.33％) with walking difficulty.All 60 cases of spinal tuberculosis had abnormal X-ray manifestations.There were abnormal physiological curvature or kyphosis in the diseased area of children,the intervertebral space of children became narrow,and the edge of vertebral body was blurred,there were widening,flattening or wedge-like changes.The operative time was (184.29 ± 23.28) min,and the intraoperative bleeding was (475.39 ± 30,28) mL.The fusion fixation segment was (10.27 ± 1.92) and the sagittal plane was (10.27 ± 1.92).Cobb angle was 106.7°,postoperative correction was 31.3°,the correction rate was 76.21％,the mean preoperative correction of thoracic kyphosis was 76.7°,postoperative correction was 15.7 °,the average correction was 55.9°,the mean sagittal deviation distance of trunk was-15.42 mm,postoperative correction was 0.63 mm,and the average correction was 20.68 mm.Conclusion Pain is the first symptom of spinal tuberculosis in children,most of them will be complicated with severe kyphosis.Surgical treatment of children with spinal tuberculosis can get better clinical results,and it is worthy of popularizing in clinic.The choice of surgical approach and fusion range is the key to the treatment process.

Clinical symptoms of spinal tuberculosis in children and the effect of surgical treatment / 中国基层医药

Objective@#To analyze the clinical symptoms of spinal tuberculosis in children and the effect of surgical treatment.@*Methods@#From October 2012 to October 2017, 60 cases of spinal tuberculosis admitted to Shanxi Dayi Hospital were selected, including 31 male children and 29 female children.The age of the children was (7.92±2.93)years old; 4 children with cervical vertebra lesions, 3 children with cervical thoracic junction lesions, 23 children with thoracic vertebra lesions, 28 children with lumbar vertebra lesions, and 2 children with lumbar sacral vertebra lesions.There were 27 children with neurological damage.Among them, 2 children with Frankel classification of A, 4 children with B, 7 children with C, and 14 children with D. All children were treated by surgery, and standing full spine X-rays were taken before and after operation.The sagittal deviation distance and sagittal Cobb angle of the children's trunk were measured, and spinal fusion and fixation of all children were recorded.@*Results@#In 52 cases (86.67%), the main symptoms were pain or radiation pain, 45 cases (75.00%) showed local palpable mass, and 7 cases (11.67%) had palpable paraspinal or abdominal mass.There were 37 cases (61.67%) with kyphosis and different degrees of spinal bulge, 11 cases (18.33%) showed abnormal sensation and limb numbness.There were 11 cases (18.33%) with walking difficulty.All 60 cases of spinal tuberculosis had abnormal X-ray manifestations.There were abnormal physiological curvature or kyphosis in the diseased area of children, the intervertebral space of children became narrow, and the edge of vertebral body was blurred, there were widening, flattening or wedge-like changes.The operative time was (184.29±23.28)min, and the intraoperative bleeding was (475.39±30.28)mL.The fusion fixation segment was (10.27±1.92) and the sagittal plane was (10.27±1.92). Cobb angle was 106.7°, postoperative correction was 31.3°, the correction rate was 76.21%, the mean preoperative correction of thoracic kyphosis was 76.7°, postoperative correction was 15.7 °, the average correction was 55.9°, the mean sagittal deviation distance of trunk was -15.42 mm, postoperative correction was 0.63 mm, and the average correction was 20.68 mm.@*Conclusion@#Pain is the first symptom of spinal tuberculosis in children, most of them will be complicated with severe kyphosis.Surgical treatment of children with spinal tuberculosis can get better clinical results, and it is worthy of popularizing in clinic.The choice of surgical approach and fusion range is the key to the treatment process.

Progress of hepatic-biliary-pancreatic surgery in the 118th annual congress of Japan Surgical Society / 中华消化外科杂志

The annual congress of Japan Surgical Society is a famous academic event in the field of surgery,and the participants can learn from the latest research results of all the major surgical disciplines.The authors selected topics of the ll8th annual congress in 2018,including the latest research results and progresses of laparoscopic hepatectony,liver transplantation,extrahepatic bile duct carcinoma and pancreatic surgery.The purpose of this study is to provide new information and reference for optimizing the diagnosis and treatment of hepatobiliary and pancreatic diseases.

Application value of dynamic SPECT 99 Tcm-GSA scintigraphy assessing regional liver function changes before and after portal vein embolization / 中华消化外科杂志

Objective To investigate the application value of dynamic single-photon emission computed tomography (SPECT) 99m-technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection (99 Tcm-GSA) scintigraphy assessing regional liver function changes before and after portal vein embolization (PVE).Methods The retrospective cross-sectional study was conducted.The clinical data of 11 patients with Bismuth Ⅲ a hilar cholangiocarcinoma who were admitted to the General Hospital of People's Liberation Army (10 patients) and Beijing Tsinghua Changgung Hospital (1 patient) from October 2010 to October 2016 were collected.B ultrasound-guided percutaneous transhepatic ipsilateral exbolization was performed before radical resection of hilar cholangiocarcinoma.Dynamic SPECT 99 Tcm-GSA scintigraphy was performed to calculate and compare the changes of functional liver volume (FLV),morphological liver volume (MLV) and functional liver density (FLD) in embolized lobe and non-embolized lobe before PVE and 2 weeks after PVE.Observation indicators:(1) the changes of serum indexes in 2 weeks before and after PVE;(2) the changes of FLV,MLV and FLD in the whole liver,embolized and non-embolized lobes in 2 weeks before and after PVE;(3) surgical and postoperative situations of hilar cholangiocarcinoma;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative serum toal bilirubin (TBil) level,with or without peritoneal effusion and survival up to June 2017.Measurement data with normal distribution were represented as x-±s.The comparisons of pre-and post-operative data were analyzed by the paired t test.Results (1) The changes of serum indexes in 2 weeks before and after PVE:11 patients underwent successful right PVE.The alanine aminotransferase (ALT),TBil,albumin (Alb),Platelets (PLT) and prothrombin time (PT) were respectively (113±20) U/L,(73± 8) μmol/L,(35.0±2.5) g/L,(209±58) × 109/L,(11.4±0.7) seconds in 2 weeks before PVE and (120± 18) U/L,(36± 7) μmol/L,(34.4± 3.2) g/L,(224± 82) × 109/L,(11.2±0.8)seconds in 2 weeks after PVE,with a statistically significant difference in TBil level (t=-10.592,P＜0.05) and no statistically significant difference in ALT,Alb,PLT and PT (t=0.981,-0.350,-0.591,0.533,P＞0.05).(2) The changes of FLV,M LV and FLD in the whole liver,embolized and nonembolized lobes in 2 weeks before and after PVE:the FLV,MLV and FLD of the whole liver were respectively (894±255) mL,(1 552±504) mL,0.59±0.14 in 2 weeks before PVE and (812±206) mL,(1 521±422) mL,0.55±0.16 in 2 weeks after PVE,with no statistically significant difference (t =1.569,0.666,1.980,P＞ 0.05).The FLV,MLV and FLD of the embolized lobe were respectively (623±275) mL,(1 047± 394) mL,0.62±0.14 in 2 weeks before PVE and (375±240) mL,(865±337) mL,0.44±0.24 in 2 weeks after PVE,with statistically significant differences (t =5.909,3.736,3.359,P ＜ 0.05);the descending percentages were respectively 38.1％,9.8％ and 24.6％.The FLV,MLV and FLD of the non-embolized lobe were respectively (274±152)mL,(530±176)mL,0.52±0.21 in 2 weeks before PVE and (436±149) mL,(656±133)mL,0.68± 0.24 in 2 weeks after PVE,with statistically significant differences (t =-6.019,-6.345,-3.933,P＜0.05);the elevated percentages were respectively 80.1％,19.9％ and 23.8％.(3) Surgical and postoperative situations of hilar cholangiocarcinoma:of 11 patients,10 received successful peri-hilar right hemihepatectomy,the right hepatic atrophy and an obvious demarcation line between left and right liver were found intraoperatively;1 stopped operation due to detect intraoperatively peritoneal metastasis of tumor.The operation time,volume of intraoperative blood loss and time of postoperative abdominal drainage-tube removal were respectively (585± 194)minutes,(472± 274)mL and (8±5)days.Of 10 patients undergoing operations,2 were complicated with massive peritoneal effusion at 2 days postoperatively,volume of peritoneal effusion remained more than 500 mL up to 7 days after drainage,and were improved by 1-month conservative treatment;other 8 patients were not complicated with hepatic dysfunction.Duration of hospital stay of 11 patients was (16± 4) days.(4) Follow-up and survival situations:10 patients were followed up for 4-72 months,with a median time of 39 months.During the follow-up,there was no evaluated TBil level and peritoneal effusion in 10 patients.The median survival time,1-,3-and 5-year overall survival rates were 88.8％,74.6％ and 36.8％,respectively.Conclusions The dynamic SPECT 99Tcm-GSA scintigraphy can effectively evaluate liver function changes of embolized and non-embolized lobes before and after PVE.The increased rate of FLV of non-embolized lobe is higher than that of MLV.

Selective Angiographic Embolization of Blunt Hepatic Trauma Reduces Failure Rate of Nonoperative Therapy and Incidence of Post-Traumatic Complications.

BACKGROUND Conflict still remains as to the benefit of angioembolization (AE) for non-operative therapy (NOT) of blunt hepatic trauma (BHT). The aim of this study was to determine whether AE could result in lower failure rates in hemodynamically stable BHT patients with high failure risk factors for NOT, and to systematically evaluate the effectiveness of AE for NOT of BHT. MATERIAL AND METHODS Medical records of all BHT patients from January 1, 1998 to December 31, 2015 at a large trauma center were collected and analyzed. Failure of NOT (FNOT) occurred if hepatic surgery was performed after attempted NOT. Logistic regression analysis was used to identify factors associated with FNOT. Hepatobiliary complications related to hepatic trauma during follow-up were reviewed. RESULTS No significant difference in FNOT for the no angiographic embolization (NO-AE) group versus angiographic embolization (AE) group was found in hepatic trauma of grades I, II, and V. However, decrease in FNOT was significant with AE performed for hepatic trauma of grades III to IV. Risk factors for FNOT included grade III to IV injuries and contrast blush on CT. Follow-up data of six months also showed that the incidence of hepatobiliary complications in the NO-AE group was higher than the AE group. CONCLUSIONS Hemodynamically stable BHT patients with grade III to IV injuries, contrast blush on initial CT, and/or decreasing hemoglobin levels can be candidates for selective AE during NOT course.

New types of operation based on perihilar resection to cure hilar cholangiocarcinoma / 中华消化外科杂志

Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected.After preoperative examinations and evaluations,single perihilar resection or combined with central liver segmentectomy were performed.Observation indicators included:(1) intraoperative situations;(2) postoperative pathological examinations;(3) postoperative situations;(4) follow-up.Patients were followed up using outpatient examination up to June 2017.Follow-up included abdominal pain,fever,routine blood test,tumor marker test and imaging examination which detected tumor recurrence and metastasis.Measurement data were represented as average (range).Results (1) Intraoperative situations:4 patients received successful operations,with an average operation time of 512 minutes (range,300-620 minutes).Portal vein was blocked continuously,with an average occlusion time of 70 minutes (range,57-80 minutes),an average volume of intraoperative blood loss was 537 mL (range,200-1 000 mL).Two patients received transfusion of 2 U plasma,4 U plasma + 4 U red blood cell (RBC),respectively.(2) Postoperative pathological examinations:results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm× 1.2 cm× 1.1 cm,1.3 cm× 1.1 cm× 1.0 cm,2.0 cm× 1.7 cm× 1.5 cm and 2.0 cm×2.0 cm× 1.5 cm.Tumor differentiation:1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma.Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis.Four patients received R0 resection.TNM staging:T2aN1M0 and T2bN1M0 were found in 1 and 3 patients,respectively.(3) Postoperative situations:of 4 patients,1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days;3 had good recovery and then discharged from hospital at day 21,14 and 14,respectively.Patients didn't receive postoperative adjuvant treatment,such as chemoradiotherapy.(4) Follow-up:4 patients were followed up for 12-31 months.During follow-up,4 patients were in good condition,and 1 with transient fever was relieved by conservative treatment.Levels of tumor marker in 4 patients were normal,results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation.Conclusion After precisely evaluating the tumor extension among segmental bile duct,single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma.

Clinical Observation of Mailuoning Injection in Adjunctive Treatment of Acute Cerebral Infarction / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of Mailuoning injection in adjunctive treatment of acute cere-bral infarction. METHODS:A total of 65 patients with acute cerebral infarction selected from neurology department of our hospital were divided into control group(32 cases)and observation group(33 cases)according to random number table. Control group was given conventional treatment. Observation group was additionally given Mailuoning injection 10 mL added into 0.9% sodium chlo-ride injection 250 mL intrnrenously,ivgtt,qd,on the basis of control group. Both group were treated for 15 d. Clinical efficacy as well as serum levels of ox-LDL,BNP and MMP-9,NIHSS score before and after treatment,the occurrence of ADR were com-pared between 2 groups. RESULTS:The response rate of observation group was 90.91%,which was significantly higher than 65.63%,with statistical significance(P0.05). After treatment,serum levels of ox-LDL,BNP and MMP-9,NIHSS score in 2 groups were all decreased significantly,and the observation group was significantly lower than the control group,with statis-tical significance (P0.05). CONCLU-SIONS:Mailuoning injection has significant therapeutic efficacy for acute cerebral infarction,can significantly reduce serum levels of ox-LDL,BNP and MMP-9,promotes neurological function and the recovery of patients with cerebral infarction with good safety.

New types of operation based on perihilar resection to cure hilar cholangiocarcinoma / 中华消化外科杂志

Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected.After preoperative examinations and evaluations,single perihilar resection or combined with central liver segmentectomy were performed.Observation indicators included:(1) intraoperative situations;(2) postoperative pathological examinations;(3) postoperative situations;(4) follow-up.Patients were followed up using outpatient examination up to June 2017.Follow-up included abdominal pain,fever,routine blood test,tumor marker test and imaging examination which detected tumor recurrence and metastasis.Measurement data were represented as average (range).Results (1) Intraoperative situations:4 patients received successful operations,with an average operation time of 512 minutes (range,300-620 minutes).Portal vein was blocked continuously,with an average occlusion time of 70 minutes (range,57-80 minutes),an average volume of intraoperative blood loss was 537 mL (range,200-1 000 mL).Two patients received transfusion of 2 U plasma,4 U plasma + 4 U red blood cell (RBC),respectively.(2) Postoperative pathological examinations:results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm× 1.2 cm× 1.1 cm,1.3 cm× 1.1 cm× 1.0 cm,2.0 cm× 1.7 cm× 1.5 cm and 2.0 cm×2.0 cm× 1.5 cm.Tumor differentiation:1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma.Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis.Four patients received R0 resection.TNM staging:T2aN1M0 and T2bN1M0 were found in 1 and 3 patients,respectively.(3) Postoperative situations:of 4 patients,1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days;3 had good recovery and then discharged from hospital at day 21,14 and 14,respectively.Patients didn't receive postoperative adjuvant treatment,such as chemoradiotherapy.(4) Follow-up:4 patients were followed up for 12-31 months.During follow-up,4 patients were in good condition,and 1 with transient fever was relieved by conservative treatment.Levels of tumor marker in 4 patients were normal,results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation.Conclusion After precisely evaluating the tumor extension among segmental bile duct,single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma.