ObjectiveTo investigate the features of liver injury in patients with coronavirus disease 2019 (COVID-19), and to provide a reference for clinical diagnosis and treatment. MethodsMedical records were collected from 201 patients with COVID-19 who were admitted to Xiangyang Central Hospital from January 19 to March 5, 2020, and these patients were divided into non-critical (mild/common type) group with 173 patients and critical (severe/critical type) group with 28 patients. The data on alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and albumin (Alb) were collected. The t-test was used for comparison of normally distributed continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and the Wilcoxon rank-sum test was used for comparison of ranked data between groups. ResultsAmong the 201 patients, 37 (18.4%) had liver injury, with 19 in the critical group and 18 in the non-critical group, and there was a significant difference in the incidence rate of liver injury between the two groups (67.9% vs 10.4%, χ2=52.963, P＜0.05). There were significant differences between the 19 patients with liver injury in the critical group and the 18 patients with liver injury in the non-critical group in the duration of abnormal ALT and/or AST (on admission and during hospitalization) (χ2=11.906, P＜0.05) and the increase in ALT and/or AST (Z=-2.869, P＜0.05), and most patients had mild or moderate liver injury. Among the 201 patients, only one patient had elevated bilirubin (TBil ＜2 × upper limit of normal, mainly indirect bilirubin) and had non-critical liver injury. The critical group had a significantly lower level of Alb than the non-critical group (t=-8.002, P＜0.05). Among the 201 patients, 75 had a reduction in Alb, among whom 50 (50/201, 24.9%) had a reduction on admission and 25 (25/201, 12.4%) had a reduction during hospitalization, and there were significant differences in Alb (t=-4.967, P＜0.05) and hypoalbuminemia (χ2=26.645, P＜0.05) between the two periods of time. ConclusionLiver injury is relatively common in patients with COVID-19, mainly mild or moderate liver injury. There is a low incidence rate of abnormal bilirubin and a high incidence rate of the reduction in Alb. There are significant differences in the incidence rate and severity of liver injury between the crucial and non-critical patients. Alb level can be used as one of the indicators to evaluate and predict the severity of COVID-19 patients.

Objective To investigate the effect of immature dendritic cell (imDC) derived from donor-derived bone marrow induced by alkaloid sinomenine (SN) on the Th1/Th2 cytokines in venous blood of receptors,and to probe into the mechanism which imDC induced by SN can lead transplantation immune tolerance.Methods Inbred strain Wistar and Sprague Dawley (SD) rats were selected as kidney transplant donor and recipient,respectively.Vessel sutures of the microsurgery technique were used to build the bilaterally renal transplantation model of rats.By the injection of imDC to the recipient rats preoperatively,enzyme-linked immunosorbent assay (ELISA) was used to determine the level of the interleukin (IL)-2,IL-4,IL-10 and interferon-γ (INF-γ).Results (1) Successful rate of transplantation was 89.5％.Arterial anastomosis time was (12.5 ±5.7)min,and venous anastomosis time was (17.3 ± 3.4)min.(2) The content of the IL-2,INF-γ,IL-4 and IL-10 in SN-imDC 106 group was (17.25 ± 3.41) pg/ml,(239.80 ± 9.06) pg/ml,(337.60 ± 25.07) pg/ml,and (1 432.00 ± 106.39) pg/ml,respectively.Among the same concentration,the level of the IL-4 and IL-10 that stood for the Th2 cytokines was significantly higher in SN-imDC group than imDC group and control group (P ＜ 0.05),and was significantly higher in SN-imDC 106 group than SN-imDC 105 group (P ＜ 0.05).Among the same concentration,the lever of IL-2 and INF-γ that stood for the Th1 cytokines was significantly lower in SN-imDC group than imDC group and control group (P ＜ 0.05),and was significantly lower in SN-imDC 106 group than SN-imDC 105 group (P ＜ 0.05).Conclusions (1) The use of microsurgery for anastomosis could make the model of singel kidney transplantation in rats.(2) Specific imDC induced by SN could induce the migration to Th2 immune response,which proved imDC induced by SN could mediate immune tolerance to the recipient.

BACKGROUND:It may be an important approach to avoiding organ transplant rejection by utilizing immature dendritic cells to induce donor-specific immunologic tolerance. OBJECTIVE:To study the effect of sinomenine on the differentiation and maturation of rat bone marrow-derived dendritic celsin vitro. METHODS:Bone marrow-derived dendritic cells were isolated from the rat femur and tibia, and immature dendritic cells were induced by granulocyte-macrophage colony stimulating factor and interleukin-4. On day 7, lipopolysaccharide was added and the cells were cultured to generate mature dendritic cells. Cells were divided into control group and low-, middle- and high-dose sinomenine treatment groups (SNL, SNM, SNH groups). Forty hours later, dendritic cels were harvested, and cell morphology was observed by inverted phase contrast microscope. The expression of CD80 and RT1B was detected by flow cytometry. ELISA was used to detect the expression of interleukin-12. The mixed lymphocyte reaction was used to detect the ability of dendritic cells to stimulate the activation of allogeneic T lymphocytes. RESULTS AND CONCLUSION: (1) Under the inverted microscope, the morphology of mature dendritic cells was observed in the control group; in the SNL group most dendritic cells were visible; in the SNM group, there were partially suspended cells with poor maturation; and in the SNH group, most of the cells were not mature. (2) The expression of CD80 in the control group was significantly lower than that in the SNL, SNM and SNH groups (P < 0.05), and the expression of RT1B was significantly reduced in the SNM and SNH groups than the control group. (3) Compared with the control group, the level of IL-12p70 in the cell supernatant was significantly decreased in the SNM and SNH groups (P < 0.01). (4) The ability of dendritic cells to stimulate T lymphocyte proliferation in the SNM and SNH groups was significantly decreased compared with the control group (P < 0.05). To conclude, sinomenine can inhibit the maturation of dendritic cells.

OBJECTIVETo explore the clinical efficacy of the chronic balloon expansion in urethral and vaginal reconstruction for high persistent cloaca.

METHODSClinical data of 21 children with high persistent cloaca undergoing chronic balloon expansion technique in Cangzhou Central Hospital and Capital Pediatric Institute from December 1996 to August 2014 were analyzed retrospectively. The balloon was continuously expand for 3 to 4 weeks. Balloon was filled with water, maintaining the internal pressure at 30 to 50 mmHg. When the diameter of the common channel was 3 cm, the plastic operations of bladder neck, urethra and vagina were performed.

RESULTSAll the 21 patients underwent primary posterior sagital urethro-vaginoplasty by using the expanded urogenital sinus. The average duration of expansion was (26.8±3.1) days and the average diameter of the urogenital sinus was increased up to (2.8±0.2) cm. Infection of urinary tract and common channel wall was not found. Histological examination demonstrated the expanded tissue consisted of a dense fibrous wall lined by a stratified squamous non-cornified epithelium, which was characterized by active cell mitoses and angiogenesis. Patients were followed up for 0.5 to 11.0 years. Efficacy was satisfactory, and no death occurred. After the operation, 9 cases reached grade I( urinary incontinence, 8 cases reached grade II( among the 17 cases with grade IIII( urinary incontinence. One patient had distal urethral dehiscence, and the secondary urethroplasty was employed six months after the operation. Urethral diameter of another 1 case dilated 9 years later, and a tighten urethral angioplasty was performed, then the urine dripping disappeared. All the children were not treated with vaginal dilatation.

CONCLUSIONChronic balloon expansion allows the creation of adequate tissue similar in appearance and type to vagina and urethra, and provides a valuable surgical alternative for managing high persistent cloaca.

Chronic Disease ; Cloaca ; Female ; Humans ; Reconstructive Surgical Procedures ; Retrospective Studies ; Urethra ; Vagina

ObjectiveTo investigate the efficacy， safety， and cost-effectiveness of endoscopic ultrasound （EUS）-guided coil placement combined with tissue adhesive injection in the treatment of gastric varices with spontaneous shunt. MethodsA retrospective analysis was performed for the patients with acute gastric variceal bleeding and spontaneous portosystemic shunt who were hospitalized and received balloon-occluded retrograde transvenous obliteration （BRTO） combined with endoscopic tissue adhesive injection or EUS-guided coil placement combined with tissue adhesive injection in Xiangyang Central Hospital from March 2019 to September 2022. The two surgical procedures were compared in terms of efficacy （technical success rate， 5-day rebleeding rate， 1-year rebleeding rate， and time to rebleeding）， safety （the incidence rate of ectopic embolism， the amount of tissue adhesive used， and the amount of lauromacrogol used）， and cost-effectiveness （hospital costs and length of hospital stay）. The t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier method was used to estimate the rebleeding. The chi-square test was used for comparison of categorical data between two groups. ResultsA total of 25 patients received successful EUS-guided coil placement and tissue adhesive injection， with a technical success rate of 100%， a median amount of 2.5 mL tissue adhesive used， a median amount of 11.0 mL lauromacrogol used， a mean length of hospital stay of 14.88±3.21 days， a mean hospital cost of 32 660.00±4 602.07 yuan， and a 5-day rebleeding rate of 0%； among these patients， 2 were lost to follow-up， and 23 patients with complete follow-up data had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 689 days. A total of 14 patients underwent modified BRTO combined with endoscopic tissue adhesive injection， with a technical success rate of 100%； a median amount of 5.0 mL tissue adhesive used during surgery， which was significantly higher than that used in EUS （U=39.000， P<0.001）； a median amount of 10.5 mL lauromacrogol used during surgery； a mean length of hospital stay of 15.38±4.94 days； a mean hospital cost of 57 583.47±18 955.40 yuan， which was significantly higher than that used in EUS （t=-6.310， P<0.001）； a 5-day rebleeding rate of 0%. No patient was lost to follow-up， and all 14 patients had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 244.50 days， with no significant difference between the two groups （χ²=1.448， P=0.229）. ConclusionEUS-guided coil placement combined with tissue adhesive injection is a relatively safe and effective technique for the treatment of gastric variceal bleeding and has a high technical success rate， a low incidence rate of serious adverse events， and similar efficacy to BRTO， with higher safety and cost-effectiveness.

Objective To investigate the prevalence, etiology, rehabilitation demands and service condition of hearing disorders based on the whole population in Jilin Province, China. Methods Using the probability proportion to size (PPS) sampling, 9246 (93.3%) out of 9909 residents sampled form 36 counties were targeted for investigation from August, 2014 to January, 2015, followed the WHO Ear and Hearing Disorders Survey Protocol. The hearing loss and disability were classified as WHO recommended and Classification and Grading Criteria of Disability (GB/T 26341-2010). Results The standardized prevalence of hearing loss and disability was 16.41%and 4.78%, re-spectively. Age, sex, residence, occupation and marriage status, education level and household income were significantly associated with hearing loss prevalence, while nationality was not. The main etiologies included non-infectious disease (47.33%), ear disease (14.17%), un-known causation (13.89%), and noise (8.59%). Among all people with hearing loss, those who accepted intervention service accounted for 11.02%. Among all people with hearing disability, those who used hearing aids accounted for 5.58%, and 0.67%used artificial cochlea. Con-clusion Demographics and socioeconomic factors are significantly associated with the prevalence of hearing loss. The main etiology con-tains non-infectious disease, ear disease and noise. Both the rate of service utilization among people with hearing loss and the rate of adopt-ing hearing aids among people with hearing disability are low. It is needed to do more in prevention and rehabilitation of hearing impairment.

Objective: To establish a near-infrared diffuse reflectance spectroscopy(NIRS) identification model for crude products,counterfeit products and processed products of Calamina by principal component analysis(PCA) and support vector machine(SVM) algorithm. Method: NIRS of crude products,counterfeit products and processed products of Calamina were collected,the characteristic spectrum segments were selected,the preprocessing method and the optimum principal component number were optimized,and the PCA-SVM qualitative model was established. Result: The characteristic spectrum segment of analysis model was 7 500-4 000 cm^-1.Spectra were preprocessed by the first-order derivative method(FD).The optimum principal component number was 5. And the optimum internal parameters of SVM[penalty factor(c)=0.25 and kernel function parameter(g)=8] were screened by applying the grid search algorithm.In the PCA-SVM qualitative model,the prediction accuracy rate was 100%for the 5-fold cross validation,and the prediction accuracy rates also were 100%both for training set and test set. Conclusion: PCA-SVM analysis model of NIRS for Calamina samples has a high prediction accuracy rate,and it can be used for the rapid and nondestructive identification of crude products,counterfeit products and processed products of Calamina by combining the diffuse reflection technique on solid powder.

Objective To reduce the risk of cervical spinal cord injury,the most medial point of the cervical intervertebral disc that the posterior percutaneous endoscopic sheath could reach was evaluated.And that could help to determine the indication of posterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation.Methods Cervical MRI images for 50 randomly selected patients,21 males and 29 females with ages from 20 to 60(average 33.5± 10.03 years),were analysed.All 50 patients underwent MRI examination at our institution between January 2014 and December 2017.As 50％ of the zygapophyseal joint was preserved,on the cross-section T2-weighted MRI images,when the sheath just touched the spinal cord,the intersection point of the medial wall of sheath and cervical spinal cord (Point L) was the most medial point of the posterior percutaneous endoscopy could get.The distance between Point L and the line through and tangent to the most lateral point of cervical disc border was the length of the line section DL.The distance between the middle sagittal line of the cervical disc and the line through and tangent to the most lateral point of cervical disc border was the length of the line section D.D1/D was the most medial distance ratio of the posterior percutaneous endoscopic cervical discectomy when 50％ of the lateral zygapophyseal joint was preserved.In the same way,D'1/D was the most medial distance ratio of the posterior percutaneous endoscopic cervical discectomy when 75％ of the lateral zygapophyseal joint was preserved.Results When 50％ of the lateral zygapophyseal joint was preserved,the upper limit of 95％ confidence intervals of the most medial distance ratio that the posterior percutaneous endoscopy could get were 78％,76％,81％,93％ in C3,4,C4,5,C5,6,C6,7 respectively.This meant that the most medial distance the posterior percutaneous endoscopy could get were the 78％,76％,81％,0.93％ of the length of the line section D in C3,4,C4,5,C5,6,C6,7 respectively.The most medial distance the posterior percutaneous endoscopy could get in C5,6 or C6,7 was longer than that in C3,4,C4,5.Conclusion When 50％ of the lateral zygapophyseal joint was preserved,the upper limit of the most medial distance ratio that the posterior percutaneous endoscopy should get were 78％,76％,81％,93％ in C3,4,C4,5,C5,6,C6,7 respectively.This meant that the most medial distance the posterior percutaneous endoscopy could get were the 78％,76％,81％,93％ of the length of line section D in C3,4,C4,5,C5,6,C6,7 respectively.If the resected disc was beyond this range,the cervical spinal cord should be in the risk of being injured.

Objective To evaluate the effect of the current immunization strategy for hepatitis B virus (Hepatitis B) in blocking mother-to-infant transmission in Hubei Province, and to explore the mechanism and possible influencing factors of failure of mother-to-infant blockade. Methods A multi-stage random sampling method was used to select 2 counties or districts in Hubei Province. Through maternity hospital health handbook, neonatal health record or hospital medical record system, hepatitis B virus (HBV) surface antigen (HBsAg)-positive pregnant women in 2012-2018 years were included to retrospectively investigate their delivery status and the HBV infection status of their children. Results Among the 302 newborns, 32 were positive for HBsAg, and the success rate of blockade of mother-to-infant transmission of hepatitis B was 89.45%. Further analysis showed that 68.21% (206 / 302) of newborns were delivered in township hospitals, 66.23% (200 / 302) were delivered by caesarean section and 41.72% (126 / 302) were breastfed, while 16.89% (51/302) were positive for hepatitis B virus e antigen (HBeAg), and 41.06% (124/302) were positive for anti-HBe. The vaccination rate of hepatitis B immunoglobulin (HBIG) during pregnancy was 3.31% (10/302), and the newborn HBIG vaccination rate was 94.37% (285/302). There were 84.11% (254/302) of pregnant women taking protective measures in daily life. Logistic regression analysis showed that township hospitals (OR=2.82, P<0.05), HBeAg positivity during pregnancy (OR=8.68, P<0.05), and HBIG vaccination during pregnancy (OR=12.62 , P<0.05) were risk factors for failure of mother-to-infant blockade, while anti-HBe positivity during pregnancy (OR=0.22, P<0.05), vaccination of newborns with HBIG (OR=0.20, P<0.05), and protective measures taken in daily life (OR=0.28, P<0.05) were protective factors for mother-to-infant interruption. Conclusion Deliveries in township hospitals and HBeAg-positivity during pregnancy are more likely to fail in blocking of mother-to-infant transmission of hepatitis B. HBIG vaccination during pregnancy does not reduce the risk of blockade failure. Neonatal HBIG vaccination, anti-HBe positivity during pregnancy, and protective measures in daily life can reduce the risk of blockade failure of mother-to-infant transmission of hepatitis B.

OBJECTIVETo investigate the basic factors of the progress amplitude of hearing and speech rehabilitation effect of preschool deaf children with cochlear implants, and provide guidance for the improvement and optimization of rehabilitation strategies.

METHODUsing the standard hearing and language assessment tools, tracked and evaluated 1 422 CI preschool deaf children for a period of one year, and calculated the effect of hearing and speech rehabilitation, carried out the correlation analysis and variance analysis among different grouping variables.

RESULT(1) There was a negative correlation (P<0.01) between the rehabilitation effect and cochlear implantation age, existed the different degree of positive correlation (P<0.01) between the rehabilitation effect and parents cultural level, but no correlation between the rehabilitation effect and parents hearing status.(2) Father's education level, in comparison to mother's education level, had greater impact on the children rehabilitation effect.(3)There was positive correlation(r=0.689, P<0.01) between the progress amplitude of hearing and speech rehabilitation effect. (4) The progress amplitude of auditory and language rehabilitation effect of 2-3 years old group was the highest value(the progress amplitude of hearing and speech recognition rate reached 77.5%, the progress amplitude of language age progress rate reached 2.02 years old), and there were significant differences (P<0.05) between over 3 years old groups.

CONCLUSIONS(1) To expect the better progress amplitude of rehabilitation effect, cochlear implant age should not be more than 3 years old. (2) Father's effect in the process of rehabilitation is more helpful for deaf children's learning enthusiasms.

Age Factors ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Deafness ; rehabilitation ; Hearing ; Hearing Tests ; Humans ; Language ; Speech Perception