Objective To study the necessirity of endocrine treatment for thyroid adenoma after operation. Methods TSH receptors were determined in 100 patient's thyroid adenoma specimens with SP method. The continuous pathologic sections of the thyroid tissues around the tumor were examined to find out that if there was any small focus. The patients were divided into two groups radnomly: Group A, patients received thyroid hormone(TH) treatment after operation; Group B, the patients received no TH treatment after operation. Blood T 3, T 4 and TSH concentration were determined, and the residual thyroid was examined with 131 I scanning and ultrasunography peroidically after operation. Results TSH receptors were presented in all of the thyroid adenomas, and small focus presented in 8% of the patients. Blood T 3, T 4, TSH and residual thyroid were normal in all patients in group A. In group B, Blood T 3, T 4 were below the normal lever in 45(90%), TSH over normal lever in 41(82%),residual thyroid hyperplasia and enlargement were found in 48 patients(96%), and thyroid nodule or tumor in 33(66%). Conclusions TH should be taken in patients with thyroid adenoma after operation to prevent high TSH of serum and tumor replapse, because these patients have the characteristics of muttiple focuses of tumor and postoperative hypothyroidism.

OBJECTIVE To analyze the bacterial distribution and drug resistance in lower respiratory tract nosocomial infection(NI).METHODS To investigate 351 patients suffered from lower respiratory tract NI using the prospective monitoring methods,and doing the pathogenic bacterium cultivation for sputums of 351 patients and then taking the susceptibility test.RESULTS Totally 346 pathogenic bacteria were found in sputums of 351 patients.The major pathogenic bacteria were Pseudomonas aeruginosa,Escherichia coli,Klebsiella and Staphylococcus aureus.ESBLs were 36.0% and 40.0%,respectively in E.coli and Klebsiella,and MRSA were 82.1% in S.aureus.Drug resistances were common in Gram-negative bacilli(GNB) and Gram-positive cocci.Piperacillin/tazobactam and cefoperazone/sulbactam and imipenem were the most sensitive for GNB,S.aureus,S.epidermidis and Enterococcus were all sensitive to vancomycin.CONCLUSIONS Drug resistance of the pathogenic bacteria in lower respiratory tract NI is common,so it′s necessary to emphasize pathogenic bacterium monitoring and use the antibacterials exactly.

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli)and Klebsiella pneumoniae (K.pneumoniae),antimicrobial use density(AUD),as well as relation between antimicrobial resistance and AUD in a ter-tiary first-class hospital.Methods Antimicrobial resistance rates of clinically-isolated E.coli and K.pneumoniae,AUD of carbapenems and quinolones,as well as relation between resistance and AUD in 2013-2015 were statistically analyzed. Results Correlation analysis of antimicrobial resistance of bacteria and AUD showed that the decrease in resistance rate of E.coli to levofloxacin was related to the decrease in the use density of quinolones(r=0.61,P=0.03);increase in resist-ance rate of K.pneumoniae to imipenem was related to the increase in the use density of carbapenems(r=0.78,P<0.01). Conclusion Antimicrobial use is one of the causes of bacterial resistance,management on antimicrobial use needs to be strengthened to reduce the threat of bacterial resistance to human health.

Objective To evaluate the direct economic loss due to surgical site infection(SSI)from a medical eco-nomics perspective,and provide basis for health administrative departments to make strategies.Methods SSI in pa-tients undergoing breast,stomach and colorectal operation between March 2008 and February 2010 were selected for 1∶1 case-control study,patients with SSI were as SSI group,without SSI during the same period were as control group,difference in medical expense and length of stay between two groups were compared,economic loss due to SSI was evaluated.Results A total of 1 523 operation cases were investigated,75(4.92%)developed SSI.69 effec-tive pairings were obtained.Wilcoxon signed rank test revealed that difference in medical expense between two groups was statistically significant(Z =6.586,P <0.001),the median of average medical expense of SSI group was 6 828.60 yuan higher than control group,all kinds of medical expense in SSI group were all higher than control group;the median length of stay of SSI group was 10 days longer than that of control group (Z = 5.939,P <0.001).Conclusion SSI can prolong hospitalization,increase medical expense,decrease bed turnover rate,and in-fluence economic income and medical quality.

Objective To evaluate the effect of bundle intervention measures on preventing ventilator-associated pneumonia (VAP).Methods Patients who were admitted to an intensive care unit(ICU)of a hospital from January 2012 to December 2013 were monitored,patients from January to December 2012 were as control group,while from January to December 2013 were as intervention group (bundle intervention measures were implemented).Usage rate of ventilators and incidence of VAP between two groups were compared.Results A total of 4 560 patients were mo-nitored,2 608 in intervention group and 1 952 in control group.Usage rate of ventilators in intervention group was lower than control group (53.95% vs 61 .17%;χ2 =65.756,P <0.01).Incidence of VAP per 1 000 ventilator days in intervention group was lower than control group (13.00‰ vs 19.56‰;χ2 =4.649,P =0.031 ).Percentage of late-onset VAP per 1 000 ventilator days in tervention group was higher than control group(41 .82‰ vs 24.59‰). Conclusion Bundle intervention measures are helpful for reducing the incidence of VAP in ICU patients.

Epstein -Barr virus hepatitis is liver inflammation caused by Epstein -Barr virus infection, mainly self -limited hepatitis or mild or moderate liver injury.It often has good prognosis, but it may progress to chronic liver disease, severe hepatitis, and even intrahepatic cholangiocarcinoma.The clinical manifestations and histopathological features of this disease lack specificity , which may lead to missed diagnosis or misdiagnosis, and thus it should be taken seriously by clinicians .This article introduces the mechanism of Epstein -Barr virus infection and reviews the research advances in Epstein -Barr viral hepatitis.

Objective To evaluate the clinical efficacy of combination of transjugular intrahepatic portosystemic shunt (TIPS) and catheter-directed thrombolysis (CDT) in the treatment of acute portal vein thrombosis (PVT) accompanied by Budd-Chiari syndrome (BCS) with extensive occlusion of the hepatic veins.Methods From March 2013 to December 2015,nine patients of acute PVT accompanied by BCS with extensive occlusion of the hepatic veins were collected,and the patients were treated by the combination of TIPS and CDT.The clinical symptoms,liver function and portal vein hemodynamics of patients were observed.After operation,portal vein and shunt patency was followed up by Doppler ultrasound.The patients were followed up seven days,one,three,six months,and every six months after the operation.Paired sample t test was performed for statistically analysis.Results The study enrolled nine patients,six male and three female,with an average age of (41.6 ± 10.9) years old.Operation was successfully performed in eight patients,and of whom three were completed under the assist of perctaneous transhepatic approach.After operation,the blood flow of portal vein was unobstructed and clinical symptoms of portal vein hypertension were obviously improved.There was no significant difference in portal vein diameter between pre-operation ((13.6 ± 2.1) cm) and seven days ((12.5±1.7) cm),one month ((12.1±2.9) cm),three months ((12.9±3.2) cm),six months ((11.6± 1.8) cm) after operation (all P＞0.05).And the portal vein velocity after operation were (79.3± 14.6),(84.4±17.3),(87.3±21.4) and (80.1±12.6) cm/s,respectively,which were higher than that before operation ((9.8 ± 3.1) cm/s),and the differences were statistically significant (t=28.169,34.713,36.519,30.314,all P＜0.01).The maximum cross sectional area ratios of the thrombus to the lumen after operation were (17.1±6.9)％,(19.1±6.2)％,(16.2±±5.5)％ and (16.7±5.1)％,respectively,which were lower than that before operation ((78.2 ±14.5)％),and the differences were statistically significant (t=26.182,23.931,29.371,27.471,all P＜0.01).At the seventh day after operation,the pressure of portal vein decreased from (42.2±8.9) cmH2O (1 cmH2O=0.098 kPa) to (19.6±4.2) cmH2O (t=17.410,P＜0.01).At seven days,one month,three months and six months after operation,albumin levels ((30.7±3.9),(30.9±4.2),(29.9±3.1) and (33.1±4.7) g/L) were all higher than that before operation ((26.5 ± 4.8) g/L),and the differences were statistically significant (t =4.785,4.874,2.874,5.402,all P＜0.05).The levels of transaminase after operation (32.9±21.6),(39.5±22.4),(24.8± 19.8),(37.1±26.9) U/L) were all lower than that before operation ((99.6±31.7) U/L),and the differences were statistically significant (t=27.624,24.913,33.671 and 25.019,all P＜0.01).During eight to 17 months follow-up,TIPS stent shunt stenosis was found in one case at three months after operation and the blood flow recovered after treatment of balloon dilation.The shunt and blood flow of portal vein of the other seven cases were clear.None of the eight patients had the symptoms of hepatic encephalopathy and pulmonary embolism.Operation was not successfully performed in one case,and 29 days later the patient died of hepatic and renal failure.Conclusion The combination of TIPS and CDT is safe and effective in the treatment of acute PVT accompanied by BCS with extensive occlusion of the hepatic veins,which maintain the blood flow of portal vein clear during short-and medium-term follow-up.

Objective To evaluate the clinical effect of endovascular interventional therapy in treating Cockett syndrome associated with deep vein thrombosis (DVT) of left lower extremity.Methods The clinical data of a total of 256 patients with Cockett syndrome complicated by DVT of left lower extremity,who were admitted to authors' hospital during the period from January 2011 to January 2015,were retrospectively analyzed.The patients were treated with catheter-directed thrombolysis,balloon dilatation of the occluded or narrowed venous segment,and/or stent implantation.The circumference differences of the affected limbs before and after treatment and the long-term patency rates were compared.Results Of the 256 patients with Cockett syndrome complicated by DVT of left lower extremity,complete dissolution of thrombus was achieved in 232 (90.6％) and partial dissolution of thrombus in 24 (9.4％).The circumference difference of thigh and calf was (7.12±2.15) and (4.57±2.81) cm respectively before and after treatment.Iliac vein reconstruction was carried out in 206 patients,among them simple balloon dilatation was employed in 46 and balloon dilatation together with stent implantation was adopted in 160.The patients were followed up for 9-24 months with a mean of 15 months.In simple balloon dilatation group,3 patients lost touch with the authors during the following-up period,26 patients (60.5％) developed iliac vein occlusion and post-embolization syndrome occurred in 21 patients (48.8％).In balloon dilatation plus stent implantation group,11 patients lost touch with the authors during the following-up period,stenosis or occlusion of the stent was seen in 13 patients (8.7％),post-embolization syndrome was observed in 15 patients (10.1％).The differences in vascular stenosis or occlusion and in the occurrence of post-embolization syndrome between the two groups were statistically significant (P＜0.001).Conclusion For the treatment of Cockett syndrome complicated by DVT of left lower extremity,catheter-directed thrombolysis and balloon dilatation combined with stent implantation carry definite clinical curative effect.

Objective:To evaluate the curative effect, safety and feasibility of percutaneous transhepatic cholangio drainage(PTCD) combined with balloon dilatation in treating benign biliary-enteric anastomosis stricture(BBES).Methods:The clinical data of 33 patients with benign biliary-enteric anastomosis stricture, who were admitted to the First Affiliated Hospital of Zhengzhou University during the period from January 2013 to May 2019, were retrospectively analyzed. There were 23 cases of benign etiology and 10 cases of malignant etiology, benign strictures of which 15 cases were located in the hepatic hilum and of which 18 cases outside of it. All patients were considered as benign stenosis by at least two imaging examinations of magnetic resonance imaging of pancreatic or enhanced MRI or enhanced CT, laboratory examinations of tumor markers and other clinical data before operation. 10 cases of malignant etiology were confirmed by intraoperative biopsy and pathology. All patients were treated with balloon dilatation at an interval of 1 to 4 weeks after PTCD. The changes of clinical symptoms, bilirubin and liver function before and after operation were compared and analyzed, and the postoperative complications and anastomotic patency rate were followed up.Results:PTCD combined with balloon dilatation was performed successfully in all patients, and the success rate was 100%. After operation, the benign biliary-enteric anastomosis stricture was significantly improved in all patients, and the clinical symptoms were improved obviously. The liver function and bilirubin decreased significantly in all patients after operation, and there was significant statistical significance ( P<0.05). There is no serious complications such as biliary bleeding and biliary fistula were found after operation. At 3 months, 6 months, 12 months, 24 months and 36 months after operation, the anastomotic patency rates of all patients were 90.9%(30/33), 72.7%(24/33), 63.6%(21/33), 63.6%(21/33), 60.6%(20/33), respectively. During the whole follow-up period, anastomotic restenosis happened in 13 patients, of which 9 cases with restenosis, the benign stenosis site of the anastomosis was the hepatic hilum and of which 4 cases located on the outside of the hepatic hilum. After treatment, the incidence of benign restenosis of the anastomosis at the hepatic hilum (60.0%, 9/15) was higher than that at outside of the hepatic hilum (22.2%, 4/18) and it's statistically significant ( P<0.05). Among the 13 patients with recurrence of BBES, 4 cases underwent choledochojejunostomy for malignant causes and 9 cases with benign causes. The recurrence rates after the first balloon dilatation were 40.0% (4/10) and 39.1% (9/23), respectively, and the average recurrence time was 5.8 months and 6.8 months respectively, the difference was not statistically significant( P>0.05). Conclusion:For the treatment of benign biliary-enteric anastomosis stricture, percutaneous transhepatic cholangio drainage combined with balloon dilatation with reliable curative effect, with high safety and less trauma, with less operative complications, and with repeatability, so it is worth applying in clinic.

Objective:To investigate the clinical value of transjugular liver biopsy (TJLB) in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods:A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University, Zhoukou Central Hospital, Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy. A total of 37 patients were included, including 21 males and 16 females, aged (53.5±11.9) years. According to different puncture points, the patients were divided into two groups: transhepatic right vein TJBL and transhepatic middle vein TJBL. The obtained liver tissue sampling effect, puncture times, complications were analyzed.Results:The success rate of TJLB was 97.3%(36/37). Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis, and the pathological diagnosis rate was 100.0%(36/36). The number of puncture times, the amount of hepatic tissue and the number of portal areas in the right hepatic vein group (21 cases) were (3.7±0.9), (3.7±0.7) and (6.5±0.9) respectively, and those in the middle hepatic vein group (15 cases) were (3.7±0.7), (3.7±0.7) and (6.3±0.8) respectively. There were no significant differences between the two groups (all P>0.05). Conclusion:TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy. Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.