Objective To evaluate the surgical treatments of refractory sclerosing peritonitis related peritoneal dialysis.Methods Clinical data of 15 patients with refractory sclerosing peritonitis related to peritoneal dialysis treated in the General Surgery Department of the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from June 30,2014 to May 30,2018.Among them,5 cases underwent"open abdomen peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",4 cases underwent"laparoscopic peritoneal catheter removal+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter",3 cases underwent"laparoscopic peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",2 cases underwent"open abdomen peritoneal dialysis catheter removal+abdominal infection flushing and drainage with catheter",and 1 case underwent"laparoscopic examination combined with laparotomy exploration and removal of lower abdominal catheter+intestinal adhesiolysis+abdominal infection flushing and drainage with catheter".Age,gender,clinical symptoms,abdominal CT examination,peripheral blood routine,blood biochemistry,blood C-reactive protein(CRP),white blood cells,biochemistry,and aetiology of peritoneal dialysis fluid were collected and followed up,and the therapeutic effect was evaluated.Results 15 patients were transferred to the Department of Surgery after ineffective treatment in the Department of Internal Medicine.Preoperatively(after 5 days of antibiotic treatment)compared to before antibiotic treatment,there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Laparoscopic exploration or laparotomy exploration was performed,during which the peritoneal dialysis catheter was removed and the abdominal infection focus was cleared.A pelvic cavity washout drainage tube was left in place postoperatively.Fourteen patients had a good recovery after surgery,with effective control of peritonitis symptoms and no complications such as intestinal obstruction or enterocutaneous fistula.After the removal of the peritoneal dialysis catheter,all patients switched to hemodialysis.A comparison of inflammatory markers before and after surgery showed a significant decrease after surgery.Three days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there were no significant changes in blood WBC,blood NEUT％,CRP,and peritoneal fluid WBC(P＞0.05).Seven days postoperatively compared to before surgery(after 5 days of antibiotic treatment),there was a significant decrease in blood WBC[(7.43±2.65)× 109/L VS(10.17±5.24)× 109/L],blood NEUT％[(88.23±9.02)％VS(85.07±11.57)％],and CRP[(152.88±113.01)mg/L VS(114.49±92.97)mg/L](P＜0.05);the peritoneal fluid WBC at 7 days postoperatively showed no significant change compared to before surgery(after 5 days of antibiotic treatment)(P＞0.05).The cases were followed up for at least 22 months,and 13 patients did not experience peritonitis or intestinal obstruction again.One patient died 39 days after surgery due to multiple organ failure,and one patient died from other causes after a 2-year follow-up.Conclusion For refractory sclerosing peritonitis related peritoneal dialysis that is ineffective in medical conservative treatment,On the basis of reasonable and effective antibiotics to control infection,surgical intervention should be actively carried out and surgical methods such as surgery should be used to control the progress of peritonitis,reduce mortality and improve the cure rate.

Objective To investigate the changes of mitochondrial respiratory function during myocardial fibrosis in mice with myocardial infarction (MI) and its correlation with the increase of glycolytic flux. Methods Forty C57BL/6N mice were randomized into two equal groups to receive sham operation or ligation of the left anterior descending coronary artery to induce acute MI. At 28 days after the operation, 5 mice from each group were euthanized and left ventricular tissue samples were collected for transcriptomic sequencing. FPKM method was used to calculate gene expression levels to identify the differentially expressed genes (DEGs) in MI mice, which were analyzed using GO and KEGG databases to determine the pathways affecting the disease process. Heat maps were drawn to show the differential expressions of the pathways and the related genes in the enrichment analysis. In primary cultures of neonatal mouse cardiac fibroblasts (CFs), the changes in mitochondrial respiration and glycolysis levels in response to treatment with the pro-fibrotic agonist TGF-β1 were analyzed using Seahorse experiment. Results The mouse models of MI showed significantly increased diastolic and systolic left ventricular diameter (P<0.05) and decreased left ventricular ejection fraction (P<0.0001). A total of 124 up-regulated and 106 down-regulated DEGs were identified in the myocardial tissues of MI mice, and GO and KEGG enrichment analysis showed that these DEGs were significantly enriched in fatty acid metabolism, organelles and other metabolic pathways and in the mitochondria. Heat maps revealed fatty acid beta oxidation, mitochondrial dysfunction and increased glycolysis levels in MI mice. In the primary culture of CFs, treatment with TGF-β1 significantly reduced the basal and maximum respiratory levels and increased the basal and maximum glycolysis levels (P<0.0001). Conclusion During myocardial fibrosis, energy metabolism remodeling occurs in the CFs, manifested by lowered mitochondrial function and increased energy generation through glycolysis.

Objective To investigate the changes of mitochondrial respiratory function during myocardial fibrosis in mice with myocardial infarction (MI) and its correlation with the increase of glycolytic flux. Methods Forty C57BL/6N mice were randomized into two equal groups to receive sham operation or ligation of the left anterior descending coronary artery to induce acute MI. At 28 days after the operation, 5 mice from each group were euthanized and left ventricular tissue samples were collected for transcriptomic sequencing. FPKM method was used to calculate gene expression levels to identify the differentially expressed genes (DEGs) in MI mice, which were analyzed using GO and KEGG databases to determine the pathways affecting the disease process. Heat maps were drawn to show the differential expressions of the pathways and the related genes in the enrichment analysis. In primary cultures of neonatal mouse cardiac fibroblasts (CFs), the changes in mitochondrial respiration and glycolysis levels in response to treatment with the pro-fibrotic agonist TGF-β1 were analyzed using Seahorse experiment. Results The mouse models of MI showed significantly increased diastolic and systolic left ventricular diameter (P<0.05) and decreased left ventricular ejection fraction (P<0.0001). A total of 124 up-regulated and 106 down-regulated DEGs were identified in the myocardial tissues of MI mice, and GO and KEGG enrichment analysis showed that these DEGs were significantly enriched in fatty acid metabolism, organelles and other metabolic pathways and in the mitochondria. Heat maps revealed fatty acid beta oxidation, mitochondrial dysfunction and increased glycolysis levels in MI mice. In the primary culture of CFs, treatment with TGF-β1 significantly reduced the basal and maximum respiratory levels and increased the basal and maximum glycolysis levels (P<0.0001). Conclusion During myocardial fibrosis, energy metabolism remodeling occurs in the CFs, manifested by lowered mitochondrial function and increased energy generation through glycolysis.

[Objective] To investigate the status and epidemiological characteristics of suspected acute respiratory tract infection (ARIS) in children at The First Affiliated Hospital of Xi’an Jiaotong University from July 2023 to June 2024, so as to provide evidence for the prevention and treatment of children in this area. [Methods] A total of 12 169 throat swab samples were collected from children with ARIS during this period, including 6 535 male children and 5 634 female children, with an age of M(Q1, Q3) of 6(3, 9) years old. Six types of respiratory pathogens were detected by multiple real-time fluorescence quantitative PCR. The children were grouped according to sex and age. Differences among groups were analyzed by χ² test, and epidemic characteristics of respiratory pathogens were explored from the perspectives of time dimension and infection type. [Results] Among the 12 169 samples, 8 241 were positive for six respiratory pathogens with a positive rate of 67.72% of which 6 823 (56.07%) were detected with single infection and 1 418 (11.65%) were detected with multiple infection. The detection rate of mycoplasma pneumonia (MP) ranked first (21.81%). Among the six pathogens, only human rhinovirus (HRV) showed statistically significant differences in gender (P=0.003). There were significant differences in the pathogens detection rate between the age groups (P<0.001), with the highest pathogens detection rate in the 6-14 years of age group (72.49%). In terms of monthly pathogen detection rate, there showed statistical differences between different months (P<0.001); except HRV, which had two peak detection rates throughout the year, the other five pathogens had only one peak detection rate and the peak months were not completely overlapping. The monthly pathogen detection rate in each age group showed a trend consistent with the overall trend, but in all months of the year, adenovirus (ADV) and MP showed higher detection rates in the age group of 3-14 years, while respiratory syncytial virus (RSV) showed higher detection rates in the age group of <3 years. Among 8 241 children infected with respiratory pathogens, the proportion of fifteen types of dual infections showed significant statistical differences (P<0.001) and ADV+ MP co-infection accounted for the highest proportion (4.02%). There were significant differences in the proportion of dual infection types among different age groups. HRV+ RSV co-infection was the highest pattern in the <1 year group (1.55%) and the 1-<3 years group (1.77%). while ADV+ MP was the most common type of co-infection in 3-<6 years group (2.94%) and 6-14 years group (5.26%). [Conclusion] Between 2023 and 2024, the pathogen patterns of respiratory tract infection of children in Xi’an were mainly single infection type and the detection rate of MP was the highest. With the increase of age, the detection rates of ADV, influenza virus B and MP increased, but RSV decreased. Except HRV, which had two peak detection rates in spring and autumn, the other five pathogens showed a trend of "staggered outbreaks" in winter and spring. While the multiple infection types were mostly dual infection, HRV+ RSV co-infection was the dominant infection type in infants (<3 years), while ADV+ MP co-infection was the dominant infection type in school-age children (3-14 years).

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective: To compare the efficacy and safety of combining diosmin with Jiuhua hemorrhoid suppository versus diosmin alone for the treatment of hemorrhoid hemorrhage. Methods: The Jiuhua hemorrhoid suppository study was conducted in 10 medical centers across China from April 1, 2019 to June 30, 2020. Patients with hemorrhoid bleeding were randomized in a ratio of 1 : 1 to either receive Jiuhua hemorrhoid suppository and diosmin tablets (the study group) or diosmin tablets alone (the control group). The suppository was used once a day after defecation or at bedtime after rinsing the anus with warm water. Diosmin tablets were administered only once a day (0.9 g). The primary endpoint of the study was the assessment of hemorrhoid bleeding relief 7 ± 2 days after treatment, classified as “very effective” “effective” and “ineffective”. The secondary endpoint included the evaluation of pain alleviation using the visual analogue scale (VAS, with scores ranging from 0 to 10) and edema (with scores ranging from 0 to 3). The safety of the two treatment regimens was evaluated 14 ± 2 days after drug administration. Results: The full analysis set (FAS) comprised 107 participants in the study group and 111 in the control group, while the per-protocol set (PPS) included 106 participants in the study group and 111 in the control group. In terms of hemorrhoid bleeding, the proportion of very effective and effective cases in the study group were significantly higher than that in the control group [106 (99.06%) vs. 91 (81.98%), P < 0.0001] in the FAS, and the PPS results [105 (99.06%) vs. 91 (81.98%), P < 0.0001] were comparable to the FAS results. The pain VAS scores at day 7 after treatment were comparable between the two groups (0.80 ± 1.17 vs. 0.80 ± 1.20, P = 0.2177). The majority of the participants in both groups had an edema score of 0 at day 7 after treatment [96 (89.72%) vs. 99 (91.67%), P = 0.370 5]. Adverse events (AEs) occurred in 9 patients (8.4%) in the study group and 3 patients (2.7%) in the control group. In addition, 5 AEs in the study group and 1 AE in the control group were possibly in association with the study drug. Conclusion Compared with the administration of diosmin oral tablets alone, the addition of Jiuhua hemorrhoid suppository to the tablets demonstrates enhanced efficacy in addressing hemorrhoid bleeding, with satisfactory patient adherence and acceptable safety.

Diabetes mellitus is one of the most common complications after liver transplantation. The survival rate of recipients after liver transplantation with diabetes mellitus and the long-term survival rate of grafts are significantly lower than those of their counterparts without diabetes mellitus. In recent years, diabetes mellitus after liver transplantation has attracted widespread attention along with the rapid development of liver transplantation in China. Although post-transplantation diabetes mellitus (PTDM) has been extensively investigated in the past two decades, multiple problems remain to be further resolved. The study was designed to review the latest research progress upon diabetes mellitus after liver transplantation, covering the definition and diagnostic criteria of PTDM, risk factors, prevention and treatment of diabetes mellitus after liver transplantation, aiming to deepen the understanding of diabetes mellitus following liver transplantation, deliver effective prevention and management, improve the long-term survival rate and enhance the quality of life of the recipients.

Objective: To explore the diagnosis value of late gadolinium enhancement(LGE) detected by magnetic resonance imaging(MRI) in acute myocardial infarction(AMI) patients. Methods: The clinical and MRI data of 52 AMI patients hospitalized from January 2016 to July 2017 in our hospital were retrospectively analyzed. All patients received medication and revascularization therapies after admission and cardiac magnetic resonance examination was performed within 1 week after admission. According to whether there was LGE, AMI patients were divided into LGE(+) group(33 cases) and LGE(-) group(19 cases). According to the existence of microvascular obstruction(MVO) and/or intramyocardial hemorrhage(IMH),LGE(+) patients were divided into MVO/IMH(+) group(18 cases) and MVO/IMH(-) group(15 cases). Results: (1)There were no statistical significance between the LGE(+)group and LGE(-)group in the age, gender,smoking history, hypertension, diabetes mellitus, dyslipidemia, ventricular arrhythmia, culprit vessel, left ventricular end-diastolic volume(LVEDV), and left ventricular end-systolic volume(LVESV) (all P>0.05). The left ventricular ejection fraction was significantly lower in LGE(+) group than in LGE(-) group( (38.7±17.6) % vs. (51.2±7.9)%, P=0.001). (2)The infarct size was positively correlated with LVEDV and LVESV(r=0.436,P=0.011;r=0.479,P=0.005,respectively), and negatively correlated with left ventricular ejection fraction (r=-0.641, P<0.001) in LGE(+) group. (3) The infarct size, LVEDV, and LVESV were significantly higher in MVO/IMH(+) group thanin MVO/IMH(-) group ((26.5±7.3)%vs. (16.2±8.3)%, P=0.001; (145.7±40.9)ml vs. (112.2±23.8)ml,P=0.009; (90.0±30.8)ml vs. (61.4±19.0)ml,P=0.004, respectively), and the left ventricular ejection fraction was significantly lower in MVO/IMH(+) group than in MVO/IMH(-) group ((29.8±15.0)% vs. (49.3±14.5)%, P=0.001). Conclusions LGE detected bycardiac magnetic resonance can provide useful information on the myocardial necrosis extent of AMI patients. Presence of MVO/IMH in LGE(+) patients is linked with larger infarct size and worse cardiac dysfunction in AMI patients.

Objeetive To investigate the relationships of CYP2C19 genotype polymorphism with platelet inhibition rate and clopidogrel low responsiveness in patients taking percutaneous coronary intervention (PCI) during perioperative administration of clopidogrel.Methods 404 patients taking clopidogrel after PCI were included from February 2016 to February 2017.They were divided into three groups:fast metaboliszer,moderate metaboliszer and slow metabolizer,according to the CYP2C19 genotype.Platelet inhibition rate induced by adenosine diphosphate (ADP) was detected by thrombelastogram,platelet inhibition rate ＜ 30％ was defined as clopidogrel low responsiveness (CLR) group and the relationships between the three groups were analyzed in view of CYP2C19 genotype and the platelet inhibition rate and the clopidogrel low responsiveness.Results (1) The proportions of the three groups was 45.5％,45.3％ and 9.2％ in the 404 patients,no statistically significant difference among the three groups in general data (age,sex,platelet,hypertension,diabetes mellitus,hyperlipidemia) (P ＞ 0.05).(2) There was no statistically significant difference in the platelet inhibition rate between the three groups (P =0.312).(3) There was no significant difference in the clopidogrel low responsiveness between the three groups (P =0.295),with the fast metabolizer group vs.intermediate metabolizer (P =0.522),the fast metabolizer group vs.the slow metabolizer (P =0.117) and the intermediate metabolizer group vs.slow metabolizer (P =0.255).Conclusion There is no correlation of CYP2C19 genotype with platelet inhibition rate and clopidogrel low responsiveness in patients taking clopidogrel after PCI.Only the detection of CYP2C19 genotype may not accurately predict the antiplatelet aggregative activity of clopidogrel.

Objective To investigate the diagnostic value of ultrasonography in radial head subluxation (RHS).Methods The clinical data and ultrasonographic findings of 34 children with RHS were retrospectively analyzed.All patients were routinely treated by bilateral compared and multi-sectional elbow joints ultrasonography.And the X ray results were negative.Results Ultrasonographic manifestations of RHS included increased radiocapitellar distance in 29 cases (29/34,85.29％);widened joint space and enhanced echo in 25 cases (25/34,73.53％);hook sign,supinator muscle above the radial head in 32 cases (32/34,94.12 ％);annular ligament entrapment in 33 cases (33/34,97.06％).Conclusion Ultra sonographic manifestations of RHS have certain characteristics.Comparation of bilateral elbow joints and the application of continuous scanning ultrasound are helpful to make a quick and accurate diagnosis of X-ray negative RHS.