Objective: To observe the effectiveness of neltimicin sulfate in treating the infections of lower respiratory tract.　Methods: 41 cases of lower respiratory tract infections served as observation subjects (treated with netilmicin sulfate 200 mg*d-1, iv drip) while the other 30 cases as control subjects (treated with penicillin 8×109 U*d-1 and ampicillin 8.0 g*d-1, iv drip).　Results: The therapeutic effectiveness was significantly higher in the observation group than that in the control group (P＜0.01). The sensitivity tests of isolates from the sputum showed that 71.1% of the isolates were highly sensitive to netilmicin sulfate, 28.9% moderately sensitive to netilmicin sulfate. The total effectiveness rate was 97.6%.　Conclusion: Netilmicin sulfate is effective in treating the lower respiratory tract infections and causes less side effects.

Objective To investigate the diagnostic value of the modified esophageal capsule endoscopy (stringed esophageal capsule endoscopy,SCE) for esophageal diseases.Methods A total of 80 patients with esophageal related symptoms underwent SCE followed by esophagogastroduodenoscopy (EGD).The examination time,detection rate of esophageal lesions,complications and adverse effects were compared.Results All patients completed the study.The mean examination time of SCE and EGD was 226.18 ± 1 10.30 seconds and 21.28 ± 8.01 seconds respectively (t =-16.665,P =0.000).A total of 119 lesions were detected by SCE and EGD,and the diagnostic accordance rate of SCE and EGD was 82.4％ (98/119).Ten lesions of advanced squamous carcinoma,5 lesions of high grade intraepithelial neoplasia and 3 lesions of early squamous carcinoma were detected by both examinations,all of which were confirmed by histopathologic examination.The overall rate of complication in SCE (1.3％,1/80) was significantly lower than that of EGD (8.8％,7/80,x2 =4.238,P =0.040) and the rates of swallow difficulty (P =0.022),throat discomfort (P =0.007) and vomiting (P =0.000) of SCE were significantly lower than those of EGD.Conclusion SCE is a feasible,easy-to-operate,safe,well tolerated and accurate method for detection of esophageal diseases,and could be a non-invasive alternative for conventional EGD.

Acute kidney injury is a common complication after liver transplantation, which severely affects clinical prognosis of liver transplant recipients. Multiple factors before, during and after liver transplantation may cause kidney injury. If not properly treated, it may progress into chronic kidney diseases, which significantly increases postoperative fatality and negatively affects clinical efficacy of liver transplantation. Therefore, prevention, diagnosis and treatment of acute kidney injury after liver transplantation is a hot topic for clinicians. In this article, the definition, diagnosis, risk factors, prevention and treatment of acute kidney injury after liver transplantation were reviewed, and potential risk factors and related therapeutic strategies during different stages of acute kidney injury after liver transplantation were analyzed, aiming to lower the risk of acute kidney injury after liver transplantation and further improve clinical prognosis of liver transplant recipients by optimizing treatment regimens.

Objective:To explore the value of endoscopic ultrasonography-guided carbon nanoparticles tattooing for preoperative localization of laparoscopic surgery for rectal cancer.Methods:Sixty patients diagnosed as having rectal cancer who underwent laparoscopic radical resection in the 900th Hospital of Joint Logistics Support Force from April 2018 to April 2019 were randomly divided into the endoscopic ultrasonography-guided tattoo group (group A), the colonoscopy-guided tattoo group (group B) and the control group (group C) by random number table. The leakage rate of dye in intestinal tract, complications, and the tattooed serosa stained with carbon nanoparticles during laparoscopic surgery were recorded. Identification time of lesions, the total operation time, the length of resected rectal segment, tumor distance to distal resection margin, and the rate of anal preservation were analyzed and the postoperative pathology were compared.Results:In group A, endoscopic ultrasonography revealed 2 cases of suspected tumor extension toward the anal side within distal intestinal wall. The extension length was 0.42 cm and 0.71 cm respectively, and the extension length was 0.36 cm and 0.64 cm under microscope respectively. In group B, the pathology result showed that the extension length was 0.53 cm under microscope. In group C, the pathology result showed that the extension length were 0.43 cm, 0.36 cm and 0.28 cm under microscope respectively. Obvious black staining in the rectal serosa was found in all tattooed patients during the surgery. There were scattered black staining spots at the surface of peritoneum and mesentery in 3 cases in group B. The identification time of lesions in group A and B were shorter than that in group C (1.29 ± 0.87 min, 1.31 ± 0.63 min VS 15.3 ± 10.50 min, P<0.05). The total operation time in group A and B were shorter than that in group C (176.12 ± 27.64 min, 175.67 ± 26.48 min VS 198.65 ± 38.67 min, P<0.05). The length of resected rectal segment in group A and B were shorter than that in group C (11.81 ± 5.76 cm, 12.31 ± 3.94 cm VS 15.24 ± 4.12 cm, P<0.05). The tumor distance to distal resection margin in group A and B were shorter than that in group C (3.61 ± 1.26 cm, 4.57 ± 1.58 cm VS 6.13 ± 2.47 cm, P<0.05). Anal preservation rates of three groups were 65.0% (13/20), 60.0% (12/20), 40.0% (8/20) respectively with no significant difference ( P>0.05). No residual tumor cells were found in any specimens. Conclusion:Carbon nanoparticles tattooing guided by endoscopic ultrasonography could reduce unnecessary intestinal segment incision and shorten the operation time. It can also reveal tumor extension toward the anal side within intestinal wall, which provides more accurate localization for the distal incision of the lower rectal cancer.

Objective To evaluate the efficacy of in-situ split liver transplantation (ISSLT) in children.Methods From June 2015 to August 2018,10 liver grafts from DBD were split in-situ.All the donors were male,and the median age of the donors was 28.5 year old (18-48 year).One left half graft and 9 left lateral lobe grafts (including 2 reduced size grafts) were transplanted to 10 pediatric recipients.Four grafts were transplanted in our center,and the rest 6 grafts were shared to other two transplant center.The primary diseases of the recipients included biliary atresia (8/10),hepatic sinus obstruction syndrome (1/10) and Alagille syndrome (1/10).The median age of the recipients was 10 month (7 month-11 year),and the mean body weight was 9.8 ± 6.6 kg (5-28 kg).Results All liver grafts were split in-situ.The mean split time of liver grafts was 88.5 ± 18.9 min.The mean weight of split grafts was 336.7-± 85.4 g.All recipients were subjected to piggyback liver transplantation.Operation time was 542.5 ± 112.1 min.Anhepatic time was 52.0 ±-13.5 min.GRWR was (3.98 ±0.96)％.GRWR of two cases was more than 5％,so segment Ⅲ was partially reduced.During the follow-up period,9 cases were alive and 1 case died due to multiple organ failure 1 day after liver transplantation.Conclusions ISSLT can enlarge the graft pool for children and achieve good results.

Objective: To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis. Methods: A retrospective study was performed on data of 15 patients with cholecystolithiasis, who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data, including situation of operation, operative time, intraoperative hemorrhage, and postoperative complications were recorded. Results: The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain, and 7 patients felt slight pain in umbilical a week after surgery. No fever, incision infection, umbilical hemia, peritonitis, and ascites were reported. The clear-liquid diet was recommended for one day after operation, and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day, and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months. Conclusion Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis, provides excellent cosmetic outcomes, and can be appropriately carried out under the strict control of surgical indications.

Background: Endoscopic screening is an effective approach for detecting early gastric cancer. The interval of endoscopic surveillance should be defined based on the risk stratification of gastric cancer, so as to improve the screening efficiency. Aims: To investigate whether gastric cancer risk could be stratified according to endoscopic atrophic gastritis grading. Methods: Subjects who underwent gastroscopy at least two times between Jan. 2015 and Dec. 2019 at the 900th Hospital of Joint Logistics Support Force, PLA were enrolled in a retrospective study. The demographic data and information on endoscopy were recorded. The extent and degree of gastric atrophy under endoscopy was graded using Kimura-Takemoto classification system. Then the subjects were allocated into mild group (none atrophy and C-1), moderate group (C-2 and C-3) and severe group (O-1, O-2 and O-3) based on the grading. The correlation of endoscopic grading of atrophy with the risk of gastric cancer was analyzed. Results: A total of 8 736 subjects were enrolled, 4 154 were in mild group (47.6%), 2 409 in moderate group (27.6%), and 2 173 in severe group (24.9%). The mean endoscopic follow-up time was (1 052±643) d, and the mean endoscopic surveillance interval was (518±271) d. The overall coincidence rate of endoscopic diagnosis and pathological diagnosis for atrophy was 88.9%. During the follow-up period, gastric cancer was detected in 41 cases; the detection rates of mild group, moderate group and severe group were 0.07%, 0.54% and 1.15%, respectively (P<0.001). Conclusions: The risk of gastric cancer can be stratified according to the endoscopic atrophic gastritis grading, which is helpful for the decision of individualized endoscopic surveillance interval.