Objective To study the HRCT appearances and diagnostic value of primary Sjgren’s syndrome ( pSS ) . Methods CT images of 12 cases of pSS were retrospectively analyzed . Results CT and HRCT scans showed pulmonary interstitial diseases in different degree mainly localized periphery of lung in all cases,the ground-glass opacity and interlobular septal thickening were preliminary features of pSS.Conclusion The ground-glass opacity of lung is active preliminary features of pSS,while the honeycombed lung is final feature of pSS.HRCT can help to determine the stage of pSS,and to estimate the prognosis in patients with pSS.

Objective To discuss the safety and effectiveness of laparoendoscopic single -site surgery (LESS)in cholecystectomy.Methods LESS and conventional laparoscopic(LC)effect were compared and analyzed in cholecystectomy.48 cases were divided into the two groups,24 cases(group LESS)were cheated by laparoendo-scopic single-site surgery;24 cases(group LC)were cheated by laparoscopic cholecystectomy.Contrasted in their operation time,intraoperative amount of bleeding,intraoperative laparotomy rate,body temperature after operation, complications,intestinal recovery time (postoperative exhaust),hospitalization time after operation,postoperative pain index,cosmetic effect,white blood cell (WBC),serum cortisol (Cortisol,Cor),immunoglobulin A (IgA)and comple-ment (C3 ).Results All cases were successful,no cases converted to laparotomy,no postoperative complications.The operation time of group LESS and group LC were (110.2 ±29.3)min and (77.8 ±31.2)min,respectively,the differ-ence was ststictically significant (t=5.07,P<0.05).The intestinal recovery time and hospitalization time after oper-ation in group LESS were less than that in gruoup LC (P<0.05 ).The cosmetic effect in group LESS (3.5 ± 0.5)was higher than that in group LC(2.1 ±0.5)(P<0.05).Cor and C3 in group LESS were higher than those in group LC(P<0.05 ).Conclusion Laparoendoscopic single -site surgery in cholecystectomy is safe and feasible, compared with traditional laparoscopic operation,operation time in LESS is long,but arapid postoperative recovery, beauty effect is obvious.

Objective To explore the relationship between esophageal carcinoma extensive infiltration and lesion length and 252 Cf intracavitary brachytherapy,and to evaluate its prognostic influence.Methods Thirty-two patients with esophageal carcinoma were treated by external beam and 252Cf intracavitary radiation.The patients were first treated with conventional fractionated radiation to a dose of 38 Gy over 4 weeks,with 5 daily fractions of 2 Gy per week,and then treated with external and intracavitary radiation concomitantly (4.0 Gy per fraction,once a week on every Saturday to 12 Gy in 3 fractions).The total dose of external irradiation was 50 Gy.Results The local control rate (LCR) at 1,3 and 5 years was 93.75％,76.70％ and 65.75％ in the patients with ≤5 cm lesion (NMT5 group),and 60.94％,27.08％ and 27.08％ in the patients with ＞5 cm lesion (MT5 group),respectively (x2 =7.01,P ＜ 0.05).The 1-,3-and 5-year survival rate (SR) was 93.75％,56.25％ and 43.75％ in the NMT5 group,and 75.00％,18.75％,12.50％ in the MT5 group,respectively (x2 =5.96,P ＜ 0.05).The LCR at 1,3 and 5 years was 92.31％,73.85％ and 61.54％ in the patients with ≤1.5 cm infiltration depth (NMT1.5 group),and 67.67％,35.45％ and 35.45％ in the patients with ＞ 1.5 cm infiltration depth (MT1.5 group),respectively (x2 =3.87,P ＜ 0.05).The 1-,3-and 5-year SR was 92.31％,61.54％ and 46.15％ in the NMT1.5 group,and 73.68％,21.05％ and 15.79％ in the MT1.5 group,respectively (x2 =6.24,P ＜ 0.05).LCR and SR in the patients with ≤5 cm lesion and ≤2 cm infiltration depth were significantly better than those with ＞ 5 cm lesion and ＞ 2 cm infiltration depth (x2 =10.09,7.97,P ＜ 0.05).Conclusions The patients with ≤5 cm lesion length or those with ≤ 1.5 cm infiltration depth,might become the most adaptable indication for 252 Cf intracavitary radiation.In addition,those patients with ≤2 cm infiltration depth and ≤5 cm lesion length were also suitable for 252Cf intracavitary radiation.

Objective: To analyze the effects of different doses of flurbiprofen and other analgesic drugs on the postoperative analgesia in the Enhanced Recovery After Surgery (ERAS) . Methods: 98 patients with jaw cysts or multiple impact teeth were retrospectively analyzed. Patients were divided into 3 groups by the drug scheme: flurbiprofen 250 mg + 0. 9％ NS to 100 ml (group Ⅰ, n =32), sulfentanil 100 μg + azasetron 20 mg + 0. 9％ NS to 100 ml (group Ⅱ, n = 34), flurbiprofen 200 mg + sulfentanil 50 μg + azasetron 20 mg + 0. 9％ NS to 100 ml (group Ⅲ, n = 32) . Analgesic effects were evaluated at 3 h, 1 d and 2 d after surgery with Wong-Baker expression scale and numeric rating scale (NRS) . Questionnaire survey was also used to evaluate degree of satisfaction on analgesia. Results: Analgesia effective rate of group Ⅰ, Ⅱ and Ⅲ was 40. 62％, 67. 65％ and 68. 75％ respectively (P ＜0. 05) . Degree of satisfaction on analgesia of group Ⅰ, Ⅱ and Ⅲ was 71. 87％, 58. 82％ and 93. 75％ respectively (P ＜ 0. 05) .Conclusion: Flurbiprofen combined with sulfentanil has good analgesic effects and low side effects in the maxillofacial surgery of jaw cysts and multiple impact teeth.

Objective: To investigate the correlation of meteorological factors with the numbers of marmots and parasitic fleas in the plague foci of Himalayan marmot in Subei County and Sunan County of Gansu Province. Methods: The surveillance data(from Gansu Provincial Center for Disease Control and Prevention) of natural plague foci of Subei, Sunan of Himalayan marmot from 1982 to 2016 and the meteorological factors data (from China Meteorological Data Sharing Service Network) such as annual average temperature, rainfall and relative humidity during the same period were collected. The correlation between marmot density, body flea index and meteorological factors were analyzed by SAS 9.3 software. Based on the meteorological data as an independent variable in current year and previous 1, 2, and 3 years (relative to previous 1, 2, and 3 years as the reference), the marmot density as the dependent variable, the time series semiparametric generalized additive model (GAM) was established to quantitatively study the nonlinear effect of meteorological factors on the marmot density by R2.3.2 software. Results: From 1982 to 2016, the marmot density in Subei County of Gansu Province was 0.29-6.63 per hectare, and the body flea index range was 0.04-4.56; the marmot density in Sunan County of Gansu Province was 1.22-7.92 per hectare, and the body flea index range was 0.06-0.42. In Subei County, the marmot density was correlated with the previous 1 year rainfall and relative humidity, respectively (r= 0.43, 0.36, P < 0.05), and negatively correlated with the average temperature of the year and the previous 1, 3 years (r=-0.58,-0.55,-0.41, P < 0.05). In Sunan County, the marmot density was correlated with the relative humidity of the year and the previous 1 year rainfall and relative humidity, respectively (r= 0.36, 0.57, 0.43, P < 0.05). In Subei County, the body flea index was negatively correlated with the average temperature of the year and the previous 1, 2, 3 years, respectively(r=-0.57,-0.43,-0.31,-0.37, P < 0.05). In Sunan County, there was a negative correlation between the body flea index and the average temperature of the year and the previous 1, 2, 3 years (r=-0.71,-0.46,-0.38,-0.40, P < 0.05). After controlling other influencing factors, the results of the GAM showed that for every 1 mm increase in rainfall of the year in Subei County, the marmot density increased 0.93%; for every 1% increase in relative humidity of the previous 3 year in Subei County, the marmot density increased 25.34%; for every 1 mm increase in rainfall of the previous 3 year in Sunan County, the marmot density increased 1.69%. Conclusions The numbers of marmots in the plague foci of Himalayan marmot in Subei County and Sunan County of Gansu Province are closely related to rainfall and relative humidity, and the influence has different hysteresis effects. Surface temperature is a important factor affecting the population of parasitic fleas.

Objective To analyze the relationship between meteorological variables and the prevalence of marmot plague in the Himalayan marmot foci of Subei County,Gansu Province.Methods The surveillance data (from Gansu Provincial Center for Disease Control and Prevention) on human plague,the meteorological factors (average rainfall,temperature,relative humidity) data (from China Meteorological Data Sharing Service Network) of the current and preceding (relative to current year as a reference) first,second and third years and meteorological factors data of the current and preceding first,second and third months in Subei of Himalayan marmot foci from 1973 to 2014 were collected.The association of positive rate of plague bacteriological detection and meteorological factors was evaluated by using SAS 9.3 software.The influence of meteorological factors on the epidemic of marmot plague was analyzed by the logistic regression analysis.Results From 1973 to 2014,6 human plague cases with 5 dead cases occurred in Subei County.The positive rate of plague bacteriological detection was positively correlated with the average relative humidity of current year and the average temperature of preceding first year (r =0.366,0.385,P ＜ 0.05),and it was negatively correlated with the average relative humidity of preceding third year (r =-0.304,P ＜ 0.05);the positive rate of plague bacteriological detection was positively correlated with the average rainfall of preceding first month (r =0.212,P ＜ 0.05),and it was negatively correlated with the average relative humidity of preceding second and third months (r =-0.196,-0.201,P ＜ 0.05).The risk factor of animal plague epidemic in marmot foci in Subei County was average temperature of current month [odds ratio (OR) =1.304,95％ confidence intervals (CI):1.195-1.422],and the protective factor was average relative humidity of preceding third month (OR =0.960,95％CI:0.932-0.988).Conclusions The prevalence of marmot plague is closely associated with meteorological factors in the natural plague foci of Subei County of Gansu Province.The temperature not only plays a role in promoting the prevalence of plague,but also has a lagging effect.Therefore,the meteorological factors can be considered as a reference of the plague prevalence in Himalayan marmot plague foci.

Objective:To analyse the effects of meteorological factors on plague epidemic in Himalayana marmot plague natural foci in Subei and Sunan counties of Gansu Province. Methods:The surveillance data of plague from 1973 to 2016 in Himalayan marmot foci of Subei and Sunan counties (from Gansu Provincial Center for Disease Control and Prevention) and the meteorological factors (rainfall, temperature, relative humidity) of current, preceding first, second and third years (the first, second and third years before the reference year, from China Meteorological Data Sharing Service System) were collected. In order to build generalized additive model (GAM), the positive rate of plague was used as dependent variable while meteorological factors of the current, preceding first, second and third years were used as independent variables. The influence of meteorological factors on plague was quantitatively analyzed by using R2.3.2 software. Results:In 2006 - 2016, compared with 1974 - 1983, the average temperature in Subei rose by 0.99 ℃, the average relative humidity rose by 3.55%RH, and the average rainfall rose by 12.16 mm; in Sunan County, the average temperature rose by 1.00 ℃, the average relative humidity rose by 2.01%RH, and the average rainfall rose by 14.60 mm. From 1973 to 2016, 11 cases of human plague with 7 cases of dead (12 cases of attack) occurred in the investigated district. The average rainfall of the preceding third year of Subei rose every 1.00 mm within a certain range, the animal plague occurred rose by 0.40%. The average relative humidity of preceding second year of Subei rose every 1.00%RH within a certain range, animal plague occurred rose by 11.66%. The average rainfall of the preceding first year of Sunan rose every 1.00 mm within a certain range, the animal plague occurred rose by 1.32%. The average relative humidity of preceding third year of Sunan rose every 1.00%RH within a certain range, animal plague occurred rose by 11.96%. The average temperature of the preceding second year of Subei, Sunan rose every 1.00 ℃ within a certain range, animal plague rose 73.17%, 70.18%, respectively.Conclusions:The occurrence and prevalence of plague in Himalayana marmot are closely related to meteorological factors, and the temperature within a certain range (but not continuously) not only promotes the epidemic of plague, but also has a lag effect. In addition, the effects of different types of climate in the same foci on the prevalence of animal plague vary.

Objective:To explore the efficacy of a flat ground exoskeleton robot in improving the walking ability of stroke survivors.Methods:Fifty-eight stroke survivors with mobility difficulties were randomly divided into a robot group ( n=29) and a control group ( n=29). In addition to routine rehabilitation, the control group received conventional walking training, while the robot group underwent exoskeleton robot-assisted gait training. The 30-minute training sessions were held twice a day, 5 days per week for 5 weeks. Before as well as after 2 and 4 weeks of treatment, everyone′s walking ability was tested using the 6-minute walk test (6MWT) and functional ambulation scale (FAC). General lower limb motor function was quantified using the Fugl-Meyer Lower Extremity assessment (FMA-LE). Moreover, gait analysis was conducted before and after 4 weeks of treatment. Results:After 2 and 4 weeks of treatment, the average 6MWT times of both groups were significantly better than before the treatment, with the improvement of the robot group significantly greater than that of the control group after 2 weeks. After 2 and 4 weeks the average FMA-LE and FAC scores of both groups had improved significantly compared with before treatment. After 4 weeks the stride frequency and gait cycle of both groups had improved significantly.Conclusions:Exoskeleton robot-assisted gait training can improve walking ability and lower limb motor function of stroke survivors about as well as conventional walking training.

Objective:To investigate the efficacy and feasibility of transthoracic implantation of permanent left atrial and left ventricular dual-chamber pacemaker for synchronous treatment of cardiac dysfunction due to idiopathic complete left bundle branch block (CLBBB) in children.Methods:The clinical data of five children with cardiac dysfunction due to idiopathic CLBBB and accepting implantation of permanent left atrial and left ventricular epicardial dual chamber pacemaker from January 2015 to July 2019 at the Pediatric Cardiologic Department of the First Hospital of Tsinghua University were analyzed retrospectively. The effects of pacemaker implantation on patients′ cardiac function and cardiac synchrony were evaluated by echocardiogram.Results:Among 5 patients, 2 were males and 3 females. At the time of pacemaker implantation, the age of these patients was 0.5-5.7 years, the left ventricle ejection fraction (LVEF) was 29%-46%, the left ventricle end stage of diastolic diameter was 30-53 mm and the mean Z score was 4.0-34.0. Pacemaker was successfully implanted for all the patients. After the implantation, medications that can suppress atrioventricular node conduction were used and sensed atrioventricular delay (SAV) parameters were modulated until patients′ QRS duration became shortest and the percentage of left ventricular pacing increased to and maintained at 97% to 100%. Patients′ QRS duration was 120-160 ms before implantation and 90-120 ms after implantation. Patients′ cardiac function began to improve 1 day to 1 month after implantation. Patients′ cardiac function normalized after a mean of 1-12 months. LVEF increased from 29%-46% to 55%-67%. During the follow-up, interventricular mechanical delay, septal-to-posterior wall motion delay, and left ventricular systolic dyssynchrony index decreased significantly: IVMD decreased from 31-62 ms to 26-50 ms; SPWMD decreased from 40-63 ms to 10-50 ms and Ts-SD decreased from 34.3-50.3 ms to 16.3-31.4 ms. The global longitudinal strain of left ventricle decreased from -7.7%--13.8% to -13.5%--20.3%.Conclusion:Cardiac dysfunction due to CLBBB in children can be treated with transthoracic implantation of permanent epicardial left atrial and left ventricular dual chamber pacemaker which can substitute three chamber pacemaker to achieve the effects of synchronous therapy that lead to reversion and normalization of cardiac function.

Objective:To study the clustered regularly interspaced short palindromic repeats (CRISPR) loci polymorphism of Yersinia pestis and its area distribution in Gansu province. Methods:A total of 203 strains of Yersinia pestis isolated from 1962 to 2014 were selected for the culture and extraction of DNA. Three pairs of CRISPR primers were used to amplify the strain DNA by PCR, and the PCR products were sequenced. The groups and genotypes of strains were determined according to the spacer and spacer arrangement of CRISPR loci in the strain. Cluster analysis was done by using the software BioNumerics 5.10. Results:A total of 16 spacers, including 9 species of YPa loci, 4 species of YPb loci and 3 species of YPc loci, were found in the 203 strains of Yersinia pestis. A new spacer of a1′ was found. The 203 strains were divided into 5 CRISPR genotypes and classified into 5 CRISPR clusters (Cb2, Ca7, Ca7′, CaΔ5′ and Ca35′). Each cluster showed significant area-specific characteristics, Cb2 was mainly distributed in Huining country and Pingchuan district, Ca7 was mainly found in Aksai Kazak autonomous country, Ca7′ was mainly found in Xiahe country, Ca35′ was mainly found in Subei Mongolia autonomous county and Yumen city and CaΔ5′ was mainly distributed in Sunan Yugur autonomous county. Conclusions:The strains from different plague foci in Gansu were distinguished by CRISPR, all kinds of clusters showed the obvious area specific characteristics. It is important to study the evolution of Yersinia pestis in Gansu and trace the molecular biology origin of human plague.