Objective To explore the feasibility of laparoscopic operations in the treatment of ovarian benign tumors. Methods A retrospective analysis of 150 cases of ovarian benign tumors treated by laparoscopic surgery (146 cases of oophorocystectomy and 4 cases of adnexectomy) from January 1997 to October 2003 was made. Results Surgery was completed successfully in all the 150 cases and no conversions to open surgery were required. Mild extraperitoneal emphysema was observed in 2 cases and no other complications occurred. The mean blood loss was 100 ml, the mean operation time was 80 min, and the mean length of hospitalization was 4 3 days. A total of 128 cases were followed up for a mean of 3 8 years. Recurrence was found in 4 cases in 38 cases of endometriosis cysts. Among 15 patients complicated with infertility, conception occurred in 6 patients after surgery, with a pregnancy rate of 40%. Conclusions Laparoscopic surgery is safe and effective for ovarian benign tumors provided patients are properly selected.

ObjectiveTo investigate the changes of renin-angiotensin-aldosterone system (RAAS) and glomerular filtration rate (GFR) in epidurally-anesthetized patients undergoing gynecological laparoscopy with 15° head-down position and low insufflation pressure. MethodsTwenty gynecological patients(ASA grade I- Ⅱ )were studied during CO2 insufflation with an intra-abdominal pressure of 1012mmHg and 15° head-down position. Arterial blood samples were obtained for the measurements of serum concentrations of plasma renin activity(PRA), angiotensin Ⅱ (All), aldosterone(ALD) and β2-microglobulin(β2-MG)by radioimmunoassay at the following five time points: before insufflation, at 10min, 30min and 60 min after insufflation respectively and after desufflation. Arterial blood gas analysis was made in 10 of the cases simultaneously. ResultsCompared with preinsufflation, there was no significant decrease in the plasma levels of PRA, All ,ALD and β2-MG during CO2 pneumoperitoneum except for PRA at 10 min after insufflation(P ＜0.05). As the time of insufflation went on, the measurements above showed a tendency of slightly increase. The PaCO2 during peritoneal CO2 insufflation was increeseing ( P ＞ 0.05) and reached its maximum at 30 min after insufflation. The pH values of 30～60 min after insufflation were significantly decreased as compared with that of before insufflation. ConclusionThe epidural anesthesia may inhibit the response of RAAS to (CO2 insufflation pressure of 10-12mmHg and has no effect on GFR during gynecological laParoscopy.

Objective:To investigate the effect of controlled low central venous pressure (CLCVP) combined with hepatic blood occlusion on blood loss and hemodynamics in hepatectomy. Methods:Sixty hepatocellular carcinoma patients with American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ undergoing hepatectomy were randomly divided into two groups. One was the group of hepatic blood occlusion (group I);the other was the group of CLCVP combined with hepatic blood occlusion (group II). During the parenchy-mal transection phase of surgery, 60.05). Likewise, no significant difference was noted in MAP and HR at different time points of the two groups (P>0.05). The CVP in groupⅡwas significantly lower than that in groupⅠat the beginning of and 20 min after the paren-chymal transection phase of the surgery. Conclusion:CLCVP combined with hepatic blood occlusion can reduce blood loss effectively during hepatectomy.

Objective To investigate the relationship between truncating mutations of APC gene and sporadic colorectal cancer,and analyze the feasibility of non-radioactive protein truncation test (PTT) in the detection of mutations of APC gene.Methods Ninety-six samples of sporadic colorectal cancer tissues ( including 44 patients with colonic cancer and 52 patients with rectal cancer) were obtained from the General Hospital of Ningxia Medical University from September 2008 to September 2010.The mutation cluster region of the APC gene was screened using digital PTT labeled with fluorescent Lys-t-RNA,with a polymerase chain reaction fragment amplified from genomic DNA serving as a tenplate for in vitro translation.The occurrence of gene mutation was determined according to the emergence of truncated peptides.The mutation cluster region of the APC gene in 46 samples of colorectal cancer tissues was analyzed by direct sequencing.The detection rates of the 2 methods were compared by chi-square test.Results Thirteen (26％) truncated peptides were detected in the 50 samples of colorectal cancer tissues.The mutation type of 4 samples is nonsense mutation,which resulted in emergence of truncated gene products.Eleven (24％) truncated peptides were detected in the 46 samples of colorectal cancer tissues.There was no significant difference in the detection rates between PTT and direct sequencing ( x2 =0.033,P ＞ 0.05 ).Conclusions Truncating mutations of APC gene are common alterations in sporadic colorectal cancer in the Chinese.Digital PTT labeled with fluorescent Lys-t-RNA is rapid and high-sensitive in screening gene mutations.

Objective To compare the detection of flu A by nucleic acid amplification assav and rapid antigen assay in nasopharynx swabs and oropharynx swabs of flu-like patients.Methods A total of 170 flu-like patients were recruited in out-patient of Youan Hospital from September to October in 2009.Both nasopharynx swabs and oropharynx swabs were collected.Flu A virus was detected by both real-time reverse transcriptation polymerase chain reaction (RT-PCR) and rapid antigen assay.The data were analyzed by chi square test.Results For nasopharynx swabs,the positive rate of nucleic acid amplification assay was 74.1%(126/170),while that of rapid antigen assay was 65.9%(112/170)(X2=2.75,P>0.05).However,for oropharynx swabs,the positive rate of nucleic acid amplification assay was much higher than that of rapid antigen assay(62.9% vs 38.8%)(X2=19.78,P<0.01).Moreover,for nucleic acid amplification assay,the positive rate of nasopharynx swabs were higher than that of oropharynx swabs (X2=4. 90, P<0. 05). For rapid antigen assay, the positive rate of nasopharynx swabs was also higher than that of oropharynx swabs (X2=24.95, P<0.01). Based on the outcome of flu A detected with nasopharynx swabs by the nucleic acid amplification assay,the sensitivities of oropharynx swabs by nucleic acid amplification assay,oropharynx swabs by rapid antigen assay, nasopharynx swabs by rapid antigen assay were 81.7%,50.0% and 94.8%, respectively; the specifieities were 90.9%, 93.2% and 95.5%, respectively;the positive predictive values were 96. 3%, 95. 5% and 98.2%, respectively; the negative predictive values were 63.5 %, 39.4 % and 72.40%, respectively; Kappa coefficients were 0.64, 0.30 and 0.75,respectively; the total coincidences were 84.1%, 61.20% and 89.4%, respectively. Conclusions The detection of flu A with nasopharynx swabs is more sensitive than oropharynx swabs, and nucleic acid amplification assay is more sensitive than rapid antigen assay.

Objective To investigate whether Bw4 motif expressed on HLA-B affects Gag-specific T cell responses in patients with acute HIV-1 infection.Methods Sequence specific primer polymerase chain reaction ( SSP-PCR) was performed for human leukocyte antigen ( HLA) typing.Peripheral blood mononuclear cells ( PBMCs) from 36 patients with six months of acute HIV-1 infection were stimulated with HIV-1 CRF01_A/E Gag peptides to detect the HIV-1 specific T cell responses by using ELISPOT assay. Results (1) The set point viral load of 18 patients carrying no Bw4 motif on HLA-B was 4.49±0.56 which was higher than that in other 18 patients carrying 1-2 Bw4 motif(s) on HLA-B (3.78±0.75) (P=0.005). (2) T cells from 26 out of 36 patients with acute HIV-1 infection responded to P24 peptides pool including 15 patients carrying no Bw4 motif on HLA-B and 11 patients carrying 1-2 Bw4 motif( s) on HLA-B, but no significant difference was observed between them (P>0.05).The magnitude of P24-specific T cell responses induced in patients carrying no Bw4 motif on HLA-B was (1317.8 ±1238.0) SFC/106 PBMCs which was greater than that induced in patients carrying 1-2 Bw4 motif(s) on HLA-B [(549.9±778.5) SFC/106 PBMCs] ( P=0.032) .The breadth of T cell responses to P24 peptides was 2(0-5) in patients carrying no Bw4 motif on HLA-B which was broader than that of patients carrying 1-2 Bw4 motif(s) on HLA-B [1(0-4)] (P=0.080).(3) The viral loads of HIV-1 infected patients carrying no Bw4 motif on HLA-B were negatively correlated with the magnitude of P24-specific T cell responses (rs=-0.482, P=0.043) and the breadth of responses to P24 peptides (rs=-0.496, P=0.036).No correlations were observed between viral loads and the magnitude or breadth of P24-specific T cell responses in HIV-1 infected patients carrying 1-2 Bw4 motif(s) on HLA-B.Conclusion Compared with HIV-1 infected patients carrying no Bw4 motif on HLA-B, the patients carrying 1-2 Bw4 motif( s) on HLA-B showed lower levels of set point viral load, weak-ened magnitude of P24-specific T cell responses and narrowed breadth of responses to P24 peptides.

Objective:To describe the implementation status of home enteral nutrition (HEN) in pediatric patients, providing reference for the management of HEN in pediatric patients.Methods:This study was a cross-sectional study. From March 2020 to May 2021, convenience sampling was used to select 161 pediatric patients who were discharged from the Children's Hospital of Fudan University and underwent HEN as participants. The survey questionnaire was designed to collect clinical data based on the research purpose.Results:Among the 161 pediatric patients who underwent HEN, congenital malformations, digestive system diseases, neurological diseases, malignant tumors, and respiratory system diseases accounted for 38.5% (62/161), 21.7% (35/161), 19.3% (31/161), 11.2% (18/161), and 9.3% (15/161), respectively. A total of 120 pediatric patients were followed up and recorded with nutritional supplements, 49 pediatric patients received whole protein nutritional supplements, 19 received amino acid nutritional supplements, 16 received whole protein nutritional supplements with homemade homogenization, 15 received short peptide nutritional supplements, seven received breast milk with whole protein nutritional supplements, five received homemade homogenization, five received animal milk, two received breast milk, and two received amino acid nutritional supplements with homemade homogenization. A total of 118 pediatric patients were followed up with tube feeding, including 107 cases using intermittent feeding, nine cases using continuous feeding, and two cases using intermittent combined continuous feeding. There were 46 children with tube slippage, nine cases of vomiting, six cases of tube blockage, three cases of abdominal pain and bloating, two cases of diarrhea, one case of nasal redness, one case of aspiration pneumonia, and one case of exudation around the stoma. After a short-term HEN, 74 cases continued to receive tube feeding, 49 cases were successfully removed from the tube and switched to oral feeding, three cases were switched to tube and oral combined feeding, five cases died due to severe illness.Conclusions:Pediatric patients undergoing HEN have a wide range of diseases and a high incidence of tube slippage. Education should be provided to family caregivers to enhance their ability to identify and handle complications, as well as to make correct choices in feeding formulations and methods. We should also establish a sound follow-up system, closely monitor the nutritional status of pediatric patients, and actively assist in preventing complications.

Objective:To construct a program for improving care ability of caregivers for children with home enteral tube feeding (HETF) based on timing theory, and explore its preliminary effects.Methods:Based on the framework of timing theory and literature review, intervention measures to improve the care ability of caregivers for children with HETF were extracted and summarized to form a preliminary program draft. Fourteen caregivers with experience in caring for children with HETF were subjected to qualitative interviews to supplement the content of the program, and the program was revised through expert meetings to form the final draft. Non-synchronous control method was adopted, and 89 children with HETF and 89 caregivers of them admitted to the Children's Hospital of Fudan University from March 2022 to February 2023 were continuously included as study subjects. The children and their caregivers included from March to August 2022 were in control group ( n=42), and the children and their caregivers included from September 2022 to February 2023 were in intervention group ( n=47), and the plan was preliminarily applied. Family Caregiver Task Inventory (FCTI) was used to evaluate the impact of the program on improving caregiver care ability. Age specific body weight z-values, height specific body weight z-values, and complications were used to evaluate the impact of the program on the growth and development of children and the incidence of tube feeding complications. The data was collected at the time of enrollment and one, two, and three months after discharge. Results:There were 66 children who completed the whole study, including 33 children in the control group and the intervention group, and 33 caregivers in each group. The application results showed that the total score of FCTI in the intervention group decreased from (25.91±2.94) at enrollment to (5.85±2.60) at three months after discharge, while the total score of FCTI in the control group decreased from (26.12±4.34) at enrollment to (12.52±3.60) at three months after discharge, and the total score of FCTI in both groups decreased over time. At one, two, and three months after discharge, the total FCTI score of the intervention group was lower than that of the control group, and the difference was statistically significant ( P<0.05). At three months after discharge, the incidence of complications in children with HETF in the intervention group was lower than that in the control group with a statistical difference ( P<0.05) . Conclusions:The program for improving care ability of caregivers for children with HETF based on timing theory is scientific and provides basis for the management of home tube feeding of children.

OBJECTIVETo explore the differential characteristics of the AMA-M2 autoantibody in patients with primary biliary cirrhosis (PBC) and non-PBC patients.

METHODSPatients with abnormal liver function at the Capital Medical University affiliated to Beijing You-an Hospital were enrolled in this study between January 2011 and December 2013. Serum levels of ANA, AMA and AMA-M2 were detected by indirect fluorescence assay and enzyme-linked immunosorbent assay. The patients' clinical data was obtained for retrospective analysis. Statistical analyses were performed using the SPSS 16.0 software. Enumeration data have been presented as numbers and percentages, and were analyzed using the chi-square test and one-way ANOVA test.

RESULTSOf the 5315 patients with abnormal liver function, 15.3% (811/5315) were AMA-M2 positive patients; among those 811 patients, 78.4% (636) had PBC, 4.4% (36) had PBC overlapping with autoimmune hepatitis (AIH), 4.4% (36) had drug-induced liver injury, 6.5% (53) had hepatitis B, 3.3% (27) had hepatitis C, 0.6% (5) had hepatitis E, 0.9% (7) had alcoholic liver disease, 0.5% (4) had non-alcoholic fatty liver, 0.8% (6) had primary hepatic carcinoma, and 0.1% (1) had infectious mononucleosis. Serum AMA-M2 level was significantly higher in the PBC patients (vs. other groups, P less than 0.001) with the exception of the patients with PBC/AIH overlap syndrome. Among the 811 patients with AMA-M2 positivity, 88.5% (718) showed AMA positivity and 91.1% (739) showed ANA positivity. Serum alanine transferase (ALT) and aspartate transferase (AST) levels were significantly higher in the drag-induced liver injury patients (527.74+/-684.65 U/L, 490.60+/-716.89 U/L) and the hepatitis E patients (1015.94 ± 165.55 U/L, 665.4 ± 297.14 U/L) than in the PBC patients (96.02 ± 115.56 U/L, 94.82 ± 83.32 U/L) (ALT: F =8.041, P < 0.001, P < 0.001; AST: F =8.066, P < 0.001, P < 0.001). Serum alkaline phosphatase (ALP; 265.16 ± 179.08 U/L) and glutamyl transferase (GGT; 332.02 ± 279.29 U/L) were significantly higher in the PBC patients than in the hepatitis B patients (135.35 ± 123.17 U/L, 140.27 ± 229.24 U/L) and the hepatitis C patients (85.65 ± 27.77 U/L, 92.70 ± 125.72 U/L) (ALP: F=3.911, P =0.01, P=0.001; GGT: F=4.081, P <0.001, P < 0.001). The serum IgM level was significantly higher in the PBC patients (4.60 ± 2.67 g/L) than in the patients with drug-induced liver injury (1.76 ± 1.15 g/L), hepatitis B (2.02 ± 1.41 g/L), hepatitis C (1.48 ± 0.92 g/L), hepatitis E (1.40 ± 0.68 g/L), alcoholic liver disease (1.57 ± 1.07 g/L), non-alcoholic fatty liver (1.05 ± 0.72 g/L), and primary hepatic carcinoma (2.64 ± 2.26 g/L) (F=16.83, P < 0.001, P < 0.001, Probability value < 0.001, Probability value < 0.05, Probability value < 0.01, Probability value < 0.05 respectively).

CONCLUSIONAlthough detection of serum AMA-M2 is an important feature of PBC diagnostic testing,there is a high ratio of serum AMA-M2 detected in patients with drug-induced liver injury, hepatitis B, C and E, alcoholic liver disease, non-alcoholic fatty liver,and primary hepatic carcinoma. The AMA-M2 positive non-PBC patients still require close observation to watch for future development of PBC.

Autoantibodies ; Beijing ; Carcinoma, Hepatocellular ; Chemical and Drug Induced Liver Injury ; Enzyme-Linked Immunosorbent Assay ; Hepatitis B ; Hepatitis C ; Hepatitis, Autoimmune ; Humans ; Liver Cirrhosis, Biliary ; Liver Diseases, Alcoholic ; Liver Function Tests ; Liver Neoplasms ; Retrospective Studies

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.