Objective To evaluate the short-term effect of elemene combined with transcatheter hepatic arterial chemoembolization (TACE) interventional therapy for the treatment of moderate and advanced liver cancer.Methods A total of 63 patients with moderate and advanced liver cancer were randomized into test group(31 cases) and control group(32 cases). Both groups were given TACE, and additionally, the test group was given intra-arterial infusion of Elemene Emulsion(400-600 mg/m2)together with MAO(Mitomycin C 4-6 mg/m2 , adriamycin 20-40 mg/m2, Oxaliplatin 50-85 mg /m2), and the control group was given intra-arterial infusion of MAO. Short-term effect was evaluated by the clinical outcomes of tumor size, progression-free survival(PFS), total survival rate and adverse reactio n. Results(1)The overall response rate(ORR) in the test group was superior to that in the control group, and the difference was statistically significant(P<0.05) .(2)PFS in the test group covered 125 days, and that in the control group covered 118 days, the difference being significant (P<0.05); the median survival time(MST) in the test group was 257 days, and that in the control group was 214 days,the difference being insignificant(P>0.05).(3) No severe toxic or side effect was found in t he twogroups, the difference being not significant(P>0.05). The test group tended to have milder adverse reaction. Conclusion Intra-arterial infusion Elemene Emulsion combined with TACE interventional therapy is effective in increasing ORR, prolonging PFS, promoting adverse reaction endure and relieving symptoms of weakness, abdominal distension and pain.

Objective To discuss the injective method, contrast agent concentration and delay time of MSCT direct venography in lower extremity vein, in order to make optimal venographic schedule. Methods Thirty-two patients with lower extremity vein diseases underwent MSCT direct venography in using different concentration and injective rate of contrast agent, and the images were analyzed. The displaying ability of MSCT direct venography in lower extremity vein segment was compared with that of X-ray venography in 22 patients. Results Blood flow correlation constructed defect was the main factor impacting image quality of CT venography in lower extremity. The image scores between the groups of injective rate 1.5 ml/s and the group of 2.5 ml/s were statistically different (χ~2=5.495, P=0.019), whereas no difference of image score was found between the group of concentration of 25% and 15% (χ~2=3.333, P=0.068). The displaying ability of CT and X-ray venography in anterior tibial vein, posterior tibial vein, popliteal vein and femoral vein was not statistically different (χ~2=2.095, P=0.148). For iliac vein, the displaying ability of CT outstripped that of X-ray venography (χ~2=8.324, P=0.004). Conclusion With the schedule of delay time 50 s, injective rate 2.5 ml/s and concentration 45 mgI/ml (nonionic 300 mgI/ml and diluted 15%), MSCT direct venography in lower extremity can acquire satisfactory image, and its displaying ability of iliac vein is better than that of X-ray venography.

Objective To elevate the achievement rate of kidney biopsy puncture through the analysis of puncture angle choice of ultrasound guided automatic kidney biopsy in 518 patients. Methods Under the guidance of color Doppler ultrasound,using the 3.5MHz probe with probe holder,we performed kidney biopsy in the degrees of 40°(group X),45°(group Y),60°(group Z) and 70°(group P) with the horizontal plane. Resnlts The total achievement ratio is 100 %. The one time success rate in group Y and group Z is 100 % (group Y, 164/164 ; group Z, 186/186) ;group X is 4.8% (22/46) ;group P is 84.4% (103/122).Conclusion The automatic kidney biopsy an- gle under the guidance of ultrasound should be between 45° and 60° with the horizontal plane which is safe and has higher achievement ratio. In the meantime, complications can be avoided.

BACKGROUND:Accumulating studies have confirmed the excellent effectiveness of local infiltration analgesia, but the literature analysis is mainly limited to within 1 day after total knee arthroplasty or shorter period.
OBJECTIVE:To study the effectiveness of local infiltration analgesia (LIA) at low concentration after total knee arthroplasty, and to observe the analgesic effect at rest and movement states.
METHODS:Thirty patients undergoing total knee arthroplasty were randomly al ocated to control group and LIA group, receiving oral non-steroidal anti nflammatory drug (celebrex) and low concentration of ropivacaine (0.1%) for epidural analgesia. Control group was injected with 0.9%saline 150 mL, while LIA group was injected with equal volume of solution include ropivacaine 300 mg, morphine 5 mg and epinephrine 10μg. The rest pain and motion pain of patients in two groups were evaluated at 6, 12, 24, 36, 48 hours after operation by using visual analogue scale. The incidence rate and degree of nausea, vomiting, numbness and muscle weakness of the legs were observed after operation. The incision healing was also recorded.
RESULTS AND CONCLUSION:Visual analogue scale pain scores in the LIA group were significantly lower than the control group at 6, 12, 24 and 36 hours at rest (P<0.05), at 6, 12, 24, 36, 48 hours on movement (P<0.05). At 6 and 12 hours, there was no difference in the rest and motion pains in the LIA groups (P>0.05). No patient appeared drowsiness, nausea, and vomiting in both groups. Two patients in each group complained of slight numbness in legs. No case influenced function exercise because of muscle weakness. Al the wounds healed and there were no incision infections in two groups. Combined with oral non-steroidal anti-inflammatory drug and low concentration of ropivacaine for epidural analgesia, the local infiltration analgesia technique in total knee arthroplasty is effective in early post-operative pain management, and produces no analgesia related adverse reactions.

OBJECTIVE:To establish a new semi-automatic drug dispensing mode,with proper cost,which falls in between full-automatic drug dispensing mode and manual drug dispensing mode,good work efficiency,standard and simple operation meth-od and meets national laws and regulations. METHODS:A semi-automatic drug dispensing system was designed,in which the in-formation in the drug dispensing sheet could be automatically printed on the drug bag,and automatic bagging,packaging and deliv-ery of drugs were realized. Such drug dispensing system included hardware(mechanical structures such as drug turntable and drug funnel,transmission device,etc.)and software control systems(the program of interface with hospital information system,micro control unit software,computer software,etc.). Through commissioning,formal operation and statistics,based on 18 oral drug dis-pensing sheets with the same contents,calculated the time of drug dispensing and the number of drug dispensing errors by 3 phar-macists respectively in manual drug bag dispensing mode and semi-automatic drug dispensing mode,to evaluate the effect of the semi-automatic drug dispensing system. RESULTS:From commissioning in May 2012 to formal operation in September 2012,the system operated normally and utility model patents were obtained. In the two modes,the total time of drug dispensing was 481 and 397 min (t=6.82,P<0.001),the numbers of drug dispensing errors were 25 and 7 (χ2=9.353 8,P=0.002 2),respectively. There was statistical significance. CONCLUSIONS:The semi-automatic drug dispensing system has higher efficiency and less num-ber of drug dispensing errors compared with manual drug bag dispensing mode and lower cost compared to full-automatic drug dis-pensing system. It deserves promotion.

Objective To study the effects of perinatal and postnatal cytomegalovirus(CMV) infection on infantile physical development and nerves mental growth. Methods We observed forty-eight cases of perinatal and postnatal CMV infection infants and twenty-two cases of non-CMV infected infants. We compared the physical development between two groups at birth ,3 months and 1 year of age, and evaluated development quotient (DQ) at 1 year of age. Results There were no significant differences of baby length,weight, head circumference between two groups at birth and 3 months (P > 0.05). The averages of baby length,weight,and head circumference were all in the normal range,which showed no significant differences between two groups(P > 0. 05). There were no significant differences in DQ of rough movement,accurate movement, adaptability, language and sociality ability between two groups at 1 year of age (P > 0.05). The averages of total DQ were in the normal range, which showed no significant difference between two groups as well (P > 0. 05). According to the evaluation hierarchies, DQ values of two groups were mostly in normal level range, and there also was no significant difference(x2 = 1. 026, P > 0. 05). Conclusion The perinatal and postnatal cytomegalovirus(CMV) infection has no significant adverse effects on infantile physical development and neuro-psychological development.

Objective To evaluate the curative effect of transcatheter arterial chemoembolization (TACE) combined with intensity modulated radiation therapy (IMRT) in treating advanced hepatocellular carcinoma (HCC),and to discuss the occurrence of adverse events.Methods A total of 59 patients with advanced HCC were enrolled in this study.The patients were randomly divided into TACE plus IMRT group (study group,n=30) and TACE group (control group,n=29).The early tumor response rate,progression free survival (PFS),median survival time (mST),and adverse reactions were analyzed.Results The early tumor response rate in the study group was 60.0％,which was significantly higher than 34.4％ in the control group (P=0.043).PFS of the study group was 260 days,which was remarkably higher than 195 days of the control group (P=0.006).The mST was 468 days in the study group,which was 431 days in the control group (P=0.195).In the study group,2 patients developed severe liver function damage,which was improved after active liver protection therapy for more than 20 days.Conclusion For the treatment of advanced HCC,TACE combined with IMRT can improve early tumor response rate and prolong PFS time,moreover,its adverse reactions can be well tolerated by patients.

Objective:To explore the impact of hypophosphatemia on the occurrence and prognosis of critically ill patient.Methods:The clinical data of critically ill patients admitted to the intensive care unit (ICU) of Tianjin First Central Hospital from October 2021 to April 2022 were retrospectively analyzed. Patients were divided into hypophosphatemia group (serum phosphorus level < 0.80 mmol/L) and non-hypophosphatemia group (serum phosphorus level ≥ 0.80 mmol/L) when they were admitted to the ICU. The following variables were also collected, including gender, age, acute physiology and chronic health evaluationⅡ(APACHE Ⅱ), sequential organ failure assessment (SOFA), serum phosphorus level, serum calcium level, serum magnesium level, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP), presence of infection and infection site, length of hospital stay, ICU stay, 28-day mortality, and mechanical ventilation time. Multivariate Logistic regression analysis was used to evaluate the relationship between each variable and the 28-day mortality. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) and 95% confidence interval (95% CI) were calculated to evaluate the predictive value of serum phosphorus levels for the prognosis of ICU patients. Results:A total of 263 patients were enrolled, including 54 patients with hypophosphatemia and 209 patients without. The SOFA score, LYM level and the infection rate of patients in the hypophosphatemia group were significantly higher than those in the non-hypophosphatemia group [SOFA score: 6.70±3.17 vs. 5.64±3.59, LYM (×10 9/L): 0.99±0.54 vs. 0.77±0.54, infection rate: 77.78% (42/54) vs. 59.33% (124/209), all P < 0.05], the NLR was significantly lower than that of the non-hypophosphatemia group [10.67 (7.08, 18.02) vs. 12.25 (7.25, 21.68), P < 0.05]. The length of hospital stay, ICU stay, and mechanical ventilation duration in the hypophosphatemia group were significantly longer than those in the non-hypophosphatemia group [length of hospital stay (days): 15 (11, 28) vs. 12 (6, 21), length of ICU stay (days): 10.35±7.80 vs 7.15±6.61, mechanical ventilation duration (days): 3 (0, 12) vs. 2 (0, 5), all P < 0.05]. There was no significant difference in the 28-day mortality between the hypophosphatemia group and the non-hypophosphatemia group [9.26% (5/54) vs. 11.00% (23/209), P > 0.05]. Multivariate Logistic regression analysis showed that APACHE Ⅱ score [odds ratio ( OR) = 1.188, 95% CI was 1.110-1.271], CRP ( OR = 1.016, 95% CI was 1.007-1.026), and NLR ( OR = 1.002, 95% CI was 0.996-1.008) were independent risk factors affecting the 28-day mortality of critically ill patients in ICU (all P < 0.05). ROC curve analysis showed that the AUC of serum phosphorus levels for predicting the length of hospital stay of critically ill patients in ICU > 10 days, ICU stay > 5 days, and mechanical ventilation duration > 5 days were 0.701 (95% CI was 0.632-0.770), 0.771 (95% CI was 0.691-0.852), 0.617 (95% CI was 0.541-0.692), respectively, all P < 0.01. Conclusion:Hypophosphatemia has some predictive value for the length of hospital and ICU stay and mechanical ventilation time in critically ill patients, but it cannot predict the 28-day mortality.

Objectives:To study the molecular characteristics, virulence gene and resistance profiles of Staphylococcus aureus ( S. aureus, SA) isolates from bloodstream infections (BSI), so as to further understand the molecular characteristics of S. aureus in pediatric patients. Methods:A total of 53 S. aureus strains in bloodstream infections from Shanghai Children′s Hospital between 2016 and 2021 were collected. Antimicrobial susceptibility test were adopted by instrumental and disk diffusion method. Thirty-two kinds of virulence genes were detected by PCR and underwent multi-locus sequence typing (MLST), Staphylococcus protein A (spa) typing and staphylococcal chromosome cassette (staphylococcal cassette chromosome mec, SCCmec) typing characterizing methicillin-resistant Staphylococcus aureus (MRSA). Statistical analysis was performed using χ 2 test or Fisher exact test. Results:MRSA isolates accounted for 50.94% of the total(27/53), with ST398-t034-SCCmecV (6/53, 11.32%) and ST59-t437-SCCmecIV (4/53, 7.55%) as the most common MRSA clones. Methicillin-sensitive Staphylococcus aureus (MSSA) isolates occupied 49.06% (26/53), among which typing ST22-t309 (3/53, 5.66%) and ST7-t091/t1685 (2/53, 3.77% each) were prevalent. Of the 53 strains, all carried ≥6 virulence genes, 33 strains (62.26%) carried ≥10 virulence genes, including 18 strains of MSSA (69.23%) and 15 strains of MRSA (55.56%). The carriage rate of pvl gene in MSSA was higher than that of MRSA isolates (12/26, 33.33% vs. 6/27, 22.22%), and sasX was only detected in MRSA isolates (4/53, 7.55%). The resistant rates of BSI-SA isolates to penicillin, erythromycin and clindamycin were 98.11%, 49.06% and 41.51%, respectively. MRSA were more resistant to clinical antimicrobial agents than MSSA. Conclusions:MRSA strains cover a high proportion in S. aureus bloodstream infection of children, with ST398-t034 and ST59-t437 being the most common clones. The virulence gene carrying rate for BSI-SA was high with a greater pvl gene carrying rate in MSSA isolates while sasX was only detected in MRSA isolates. More clinical attention should be paid to the high resistance status and virulence genes characteristics of BSI-SA.

Immunothrombosis refers to the innate immune response caused by thrombosis in blood vessels(especially microvessels).Immunothrombosis is related to immune cells and specific thrombosis related molecules,producing intravascular scaffolds that promote pathogen recognition,inhibition,and destruction,thereby protecting the integrity of the host.However,abnormal or uncontrolled activation of immunothrombosis may be harmful to the host and serve as the foundation for various infectious and inflammatory related thrombotic diseases.Therefore,understanding the potential mechanisms of immunothrombosis plays a decisive role in developing more effective therapies for thrombosis treatment and prevention.This review provides an overview of the mechanisms of immunothrombosis in order to understand new treatment strategies for reducing the risk of immunothrombosis.