Objective To investigate the applicative value of micro-surgery in the treatment of cerebral aneurysms.Methods During January 2011 to January 2013 in our hospital,90 patients with cerebral aneurysm were randomly divided into the endovascular group and the microsurgical clipping group (n =45 each).The endovascular group were treated with endovascular interventional treatment,and the patients of the microsurgical clipping group were treated with microsurgical clipping treatment.The aneurysm occlusion rate and recurrence,time of hospital stay,complications and prognosis were compared between the two groups.Results The complete occlusion rate was higher [97.8％ (44/45) vs.88.9％ (40/45) and the recurrence rate was lower 2.2％ (1/45) vs.13.3％(6/45) in microsurgical clipping group than in endovascular intervention group x2 =4.34 and 3.54,P=0.031 and 0.042),all P＜0.o5.The average time of hospital stay was longer in the endovascular intervention group than in the microsurgical clipping group [(19.3 4.4) days vs.(16.34.9) days,t 1.93,P=0.035].The good rate was higher in microsurgical clipping group than in endovascular intervention group [91.1％ (41/45) vs.77.8％ (35/45),x2=6.325,P=0.012].Conclusions Microsurgical clipping surgery can significantly raise the complete occlusion of cerebral aneurysms,reduce recurrence in patients with cerebral aneurysm,decrease the hospitalization time,and improve prognosis,which is worthy of clinical application.

Objective To understand the current management situation of hand hygiene (HH)among health care workers(HCWs)in stomatology medical institutions in Zunyi,and provide basis for the scientific management of HH.Methods In October-December 2014,the on-site observation and questionnaire survey were adopted to investigate current management situation of HH in 127 stomatology medical institutions in Zunyi.Results The rates of qualified installation of sink,faucet,detergent,alcohol-based hand rub,and hand-drying facilities were 60.63%, 11 .02%,92.13%,22.05%,and 37.80% respectively.Except detergent and sink,the installation of other HH supplies in stomatology medical institutions in Zunyi were not ideal.The correct rate of HH among HCWs was 33.07%(42/127),qualified rates of HH methods among HCWs in departments of stomatology,comprehensive out-patient departments, stomatological clinics,and teeth-cleaning clinics were 50.00%,23.08%,23.53%,and 0 respectively.Conclusion HH facilities are not perfect in primary stomatology medical institutions in Zunyi,health ad-ministrative departments’supervision on HCWs’HH is inadequate,the awareness rate of HH knowledge and com-pliance to HH among HCWs are both low.

Objective To compare the clinical effects and adverse effects of microwave ablation (MWA) with sorafenib and sorafenib monotherapy in the treatment of advanced-stage hepatocellular carcinoma (HCC).Methods Medical records and follow-up information of 57 patients with advanced-stage HCC were retrospectively reviewed.25 patients were treated with MWA combined with sorafenib (combined group),and 32 patients were treated with sorafenib monotherapy (monotherapy group).The end points were therapeutic effect,progression-free survival (PFS),overall survival (OS) and adverse reactions.Results The objective response rate in the combined group was similar to the monotherapy group (16.0％ vs.3.1％,x2 =1.521,P =0.217).The disease control rate in the combined group was significantly higher than that in the monotherapy group (80.0％ vs.50.0％,χ2 =5.429,P =0.020).The median PFS in the combined group was longer than that in the monotherapy group (6.0 months vs.3.2 months,x2 =7.675,P =0.006),but the median OS was similar (11.5 months vs.8.5 months,x2 =2.480,P =0.115).The serious adverse reactions were similar between the two treatment groups (44.0％ vs.34.4％,x2 =0.549,P =0.459).Conclusion MWA plus sorafenib is superior to sorafenib alone with respect to PFS in patients with advanced-stage HCC,although it may not improve OS,with no increased risk of serious adverse reactions.

Objective To investigate the effects of two cholesterol-lowering probiotics, DM9054 (Lac-tobacillus Rhamnosus GG, LGG) in combination with 86066 (Lactobacillus plantarum WCFS1, LP), on the metabolism of bile acid via a rat model of non-alcoholic fatty liver disease (NAFLD) and the possible mecha-nism. Methods Twenty-one SD male rats were randomly divided into three groups including control group, NAFLD model group and probiotics intervention group. Rats in the control group received normal diet. The rat model of NAFLD was established by feeding rats with chronic high fat diet (45% of calories derived from fat di-et) for 20 weeks. Rats in the probiotics intervention group were given high fat diet together with cholesterol-low-ering probiotics through oral gavage. General indexes of each group including body weight and the levels of tri-glyceride, cholesterol and CK18-M30 in serums samples were detected. The expression of cholesterol 7-alpha hydroxy-lase (CYP7A1), fibroblast growth factor receptor 4 (FGFR4), farnesoid X receptor (FXR), fibroblast grwoth factor 15 (FGF15) and apical sodium-dependent bile acid transparter(ASBT) at mRNA level were de-tected by using real-time polymerase chain reaction (real-time PCR). Western blot assay was used to detect the protein expression of CYP7A1, FXR in liver tissues and ASBT in ileum tissues. The expression of FXR in liver and ileum tissues were analyzed by immunohistochemistry. Results Rats with NAFLD showed loss of body weight and decreased levels of the serological markers after treating with the probiotics (P<0. 05). Compared with the rats in model group, enhanced expression of CYP7A1 and inhibited expression of FXR in liver tissues, activated FXR-FGF15 pathway in ileum tissues as well as down-regulated expression of ASBT in ileum tissues were detected in rats receiving probiotics intervention (P<0. 05). No significant difference in the expression of FGFR4 at mRNA level was observed between NAFLD rats with or without probiotics intervention (P>0. 05). Conclusion Probiotics intervention might up-regulate the expression of CYP7A1 by suppressing the FXR path-way in liver tissues and inhibiting the expression of ASBT in ileum tissues. Treating NAFLD rats with cholester-ol-lowering probiotics could activate the FXR-FGF15 pathway in ileum tissues and enhance the metabolism of bile acid, which contributed to the alleviation of NAFLD.

ObjectiveTo explore the efficacy and toxicity of nimotuzumab plus chemotherapy in the treatment of metastatic gastrointestinal tumor.MethodsObservationgroup 22 patients with metastatic gastrointestinal tumor with confirmed diagnosis,were treated with nimotuzumab in combination chemotherapy.Nimotuzumab was given 200 mg weekly for at least six weeks. Control group 21 patients with metastatic gastrointestinal tumor with confirmed diagnosis were treated with only chemotherapy.ResultsThe effects of observation group could be observed in 22 patients, the rate of response(RR)was 31.8％ (7/22), and the disease control rate (DCR) was 72.7 ％ (16/22).QOL was improved.The effects of observation group could be observed in 21 patients,RR was 14.3 ％ (3/21),and the disease control rate was 42.8 ％ (19/21).DCR and QOL improvements were statistically significant different between the two groups.(x2=3.939,x2=4.250,P＜0.05).The two groups had no significant difference in RR and toxicity.ConclusionNimotuzumab in combination with chemotherapy is effective and can improve the disease control rate, toxicity, tolerance,quality of life.

Objective The article described the design and building of a virtual reality technology-based rehabilitation system for patients with cognitive deficits, including overall idea, design and structure of the system, the key technology, such as formal description of the training data, man-machine interactive control, controlling simulation of the training process and virtual environment module development to achieve system implementation. The system is suitable for our country and military. It will create a new way for the cognitive rehabilitation and help to promote the application of virtual reality technology in rehabilitation

Objective:To observe the changes of retinal blood flow density and thickness in the macular region of eyes with high myopia (HM) combined with peripapillary intrachoroidal cavitation (PICC).Methods:A cross-sectional study. From March 2019 to May 2021, 65 patients (65 eyes) diagnosed as PICC (HM+PICC group) in Eye Hospital, China Academy of Chinese Medical Sciences, sex-and age-matched 69 HM patients of 69 eyes (HM group) and 65 healthy people of 65 eyes (control group) were enrolled in this study. The optical coherence tomography angiography was used to scan macular areas in 3 mm×3 mm, and measure the macular fovea and optic disc on superior, inferior, nasal, temporal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density in the foveal and parafoveal region, and macular retinal ganglion cell complex (mGCC) thickness, full retinal thickness. One-way analysis of variance were used to test the difference of the index values among three groups, and then two groups were compared with Bonferroni test. A paired t-test was used to test the difference of the macular vessel density and thickness between the superior and inferior hemifield in three groups. Pearson partial regression analysis was used to calculate the correlations between them at same sites. Results:PICC was located most frequently at the inferior temporal disc border, followed by the inferior nasal region, superior temporal region, and superior nasal region in the HM+PICC group on 57(87.7%, 57/65), 25(38.5%, 25/65), 3(4.6%, 3/65) and 1(1.5%, 1/65 ) eye. There were significant differences in the global and regional full retinal thickness, mGCC thickness, SCP and DCP vessel density among 3 groups ( F=29.097, 51.929, 16.253, 6.135; P<0.001). The macular SCP and DCP vessel density except in the fovea, all regional macular full retinal thickness and mGCC thickness in the HM+PICC group were significantly lower than those in the normal group ( P<0.05). Compared to the HM group, the HM+PICC group had lower all regional mGCC thickness and SCP vessel density, as well as full retinal thickness in the inferior hemifield and DCP vessel density in the foveal region ( P<0.05). Macular vessel density and thickness in the inferior hemifield were significantly lower than those in the superior hemifield ( t=6.356, 11.693, 6.212, 2.936; P<0.01). Pearson partial regression analysis showed the SCP vessel density was positively correlated with corresponding mGCC thickness and full retinal thickness ( r=0.584, 0.534, 0.592, 0.496, 0.485, 0.517; P<0.001). However, there was no significant correlation between the DCP vascular density and mGCC thickness ( P>0.05), and only a weak positive correlation between the DCP vascular density and the full retinal thickness in the inferior hemifield ( r=0.319, P=0.014). However, no association with average and superior full retinal thickness ( r=0.066, 0.002, 0.125, 0.184, 0.016, 0.319; P>0.05). Conclusion:The macular SCP vessel density, mGCC thickness and the full retinal thickness in the inferior hemifield in PICC eyes are lower than those in the HM eyes, especially the mGCC thickness and SCP vessel density in the inferior hemifield, and there is a strong positive correlation between them.

Objective:By analyzing the clinical data of patients with primary duodenal adenocarcinoma (PDA), the risk factors affecting the postoperative prognosis of PDA patients were discussed.Methods:The clinical data of 191 patients diagnosed with PDA in Peking University First Hospital from Jan 2009 to Dec 2022 were collected. The survival rate was calculated and the survival curve was plotted by Kaplan-Meier method. Univariate analysis was performed by Log-Rank test, and multivariate analysis was performed by COX proportional hazards regression model to obtain independent risk factors.Results:The median age of onset in patients with PDA is 65 years old, and the most common symptoms are abdominal pain and abdominal distension. Prognostic analysis showed that the survival rates at 1, 3 and 5 years were 73.8%, 44.6%, and 23.0%. The analysis of Cox risk proportional regression model showed that preoperative CA19-9 level, depth of tumor invasion, degree of differentiation, TNM stage, and surgical mode were independent risk factors for the prognosis of PDA (all P<0.01). Conclusion:The overall incidence of PDA is low, but the prognosis is rather poor. Multvariable factors are associated with its prognosis and surgery is still the mainstay for hope of cure.

Objective:To evaluate whether additional radical surgery is necessary following non-curative endoscopic resection of early colorectal cancer.Method:Clinicopathological data in 104 patients following non-curative endoscopic resection of early colorectal coucer at the Department of General Surgery, Peking University First Hospital between Jan 2011 and Dec 2021.Results:Lymph node metastasis and/or residual cancer was found in 23 patients (22%), including 12 cases of lymph node metastasis, 7 cases of residual cancer and 4 patients with both residual cancer and lymph node metastasis. Univariate analysis indicated that vascular infiltration, positive vertical margin, and female gender were risk factors for lymph node metastasis. Risk factors for residual cancer were tumors ≥2 cm in size, negative lift sign, infiltration depth of ≥1 000 μm, and positive horizontal and vertical margins. Multivariate Logistic regression analysis revealed that vascular invasion, positive vertical margins, and being female were independent risk factors for lymph node metastasis, while positive vertical margins was independent risk factor for residual cancer. Salvage surgery lasted for a median of 184 (156-233) minutes, with an estimated blood loss of 50 (20-100) ml and an average postoperative hospital stay of 9 (8-11) days. Seven cases of Clavein-Dindo Ⅱ or higher complications were observed, including pulmonary embolism in 1 case , anastomotic leakage in one, lymphatic fistula in one, bowel obstruction in 2 cases and urinary tract infection in 2 cases.Conclusion:Salvage surgery is mandatory for early endoscopic non-curative resection of colorectal cancer.

Objective To explore the effects of heating intravenous fluid infusion and blood transfusion based on guidelines in severe trauma patients with hypothermia. Methods A total of 40 severe trauma patients with hypothermia admitted from July 2014 to December 2015 were enrolled as the control group treated with routine measures to maintain the body temperature at normothermia by such as electrical heating blanket; other 40 severe casualties with hypothermia admitted from January 2016 to July 2017 were recruited as the warming up group treated with heating intravenous fluid infusion and blood transfusion by hot water bath in addition to the routine measures for keeping body temperature at normothermia. The differences in core body temperature, prothrombin time, activated partial thromboplastin time, incidence of shivering and mortality rate were compared between the two groups. Results There was statistically signifi cant difference in core body temperature at 0.5 h, 1.0 h, 1.5 h, 3.0 h between the two groups (P<0.05). Though the prothrombin time and shivering were improved after warming up in both groups, and there were significant differences in prothrombin time at 3.0 h after warming up and the incidence of shivering between two groups(P<0.05).There was no signifi cant difference in mean arterial pressure at all seven intervals between two groups. Conclusion The heating intravenous fl uid infusion and blood transfusion had remarkable effects to prevent hypothermia, improves blood coagulation and reduced the incidence of shivering to provide more simple and convenient warming up intervention for clinical practice.