This paper summarizes the observation and nursing of patients with postoperative complications following percuta-neous transhepatic cholangogrphic drainage(PTCD) and biliary tract stent implantation for malignant obstructive jaundice. A-mong thirty-two patients,eight had postoperative complications,including two with biliary tract hemorrhage,four with biliary tract infection,one with pneumothorax and one with bile leakage. All the thirty-two patients recovered well in clinical symptoms and quality of life. To attach importance to psychological nursing and postoperative health education are the key points in nursing care of patients with PTCD,which play important roles in alleviating clinical symptoms,improving treatment outcome and pro-moting the patients' quality of life.

Abstract： Objective　To analyze and summarize the early clinical characteristics of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children, and to explore its related risk factors. Methods　A retrospective analysis was conducted on the clinical data of 518 patients with Mycoplasma pneumoniae pneumonia (MPP) admitted to the Department of Critical Care Medicine of Wuhan Children's Hospital from January 2020 to December 2023. According to the severity of the disease and treatment outcomes, the patients were divided into the RMPP group (n=127) and the general group (n=391). The differences in clinical features and laboratory indexes between the two groups were compared, and the risk factors of RMPP were screened out by logistic regression analysis. Results　There were no significant differences in gender, weight, onset season, and personal or family allergy history between the two groups (P>0.05). When categorized by age, the incidence of RMPP in the infant group (<3 years old, 18.92%) was lower than that in the preschool group (3-6 years old, 47.88%) and school-age group (>6 years old, 33.20%) (P<0.05), with no significant difference between the preschool group and school-age group. The probability of high fever, duration of fever, and duration of macrolide medication use in the RMPP group were significantly higher than those in the general group (P<0.05). The incidences of shortness of breath, diarrhea, convulsions, and rash in the two groups of children were also significantly different (P<0.05). There was a significant difference in white blood cell count, C-reactive protein, procalcitonin, lactate, blood urea nitrogen, alanine transaminase, D-dimer, interleukin-6 in the RMPP group were higher than those in the general group, with statistical significance (P<0.001). Among the 308 children in the general group who completed Mycoplasma pneumoniae DNA testing, the positive rate of Mycoplasma pneumoniae resistance sites was 57.47% (177/308), which was significantly lower than that of the RMPP group (76.38%, 97/127) (P<0.001). The rate of bacterial and viral co-infection in the RMPP group (59.84%) was significantly higher than that in the general group (P<0.001). The number of cases of pulmonary consolidation, atelectasis, and pleural effusion in the RMPP group was significantly higher than those in the general group (P<0.001). Multivariate logistic regression analysis showed that the duration of fever, bacterial co-viral infection, and positive Mycoplasma pneumoniae resistance gene loci were independent risk factors for RMPP. Conclusions　RMPP is more common in children over 3 years old and tends to occur in autumn and winter, and its early clinical symptoms are not typical. Clinical doctors should be highly vigilant about the occurrence of RMPP in patients who have prolonged fever despite macrolide treatment, bacterial and viral co-infections, or develop extrapulmonary complications (diarrhea, convulsions, rash). It is recommended that Mycoplasma pneumoniae resistance gene loci testing be performed as soon as possible, which can help to identify RMPP in the early stage.

Objective:To explore the efficacy and safety of ornidazole in the treatment of trichomonal vaginitis. Methods:Totally 112 cases of trichomonal vaginitis from February 2011 to December 2012 in our hospital were selected and randomly divided into the ob-servation group and the control group with 56 cases in each. The control group was treated with metronidazole tablets 200mg, po,tid, and the observation group was treated with ornidazole tablets 500mg, po,bid. The treatment course was 7 days. The clinical effect, score of clinical symptoms and incidence of adverse reactions of the two groups were compared. Results:The total effective rate of the observation group was 96. 4%, which was higher than that of the control group (82. 1%), and the difference was statistically signifi-cant (P<0. 05). The symptom scores of the two groups were significantly improved after the treatment (P<0. 05), however, the score between the two groups showed no significant difference (P>0. 05). The incidence rate of adverse reactions in the observation group was 10. 71%, which was significantly lower than that in the control group (37. 5%), and the difference was statistically signifi-cant (P<0. 05). Conclusion:The clinical curative effect of ornidazole in the treatment of trichomonal vaginitis is notable with faster onset, shorter treatment course, lower adverse reaction rate and better patient tolerance,which is valuable in the clinical promotion.

Objective To investigate the stimulating effects of activin A(ACT-A) and follistatin(FS) on the secretion of type I collagen(Col I) and the expression of Col I mRNA of cultured rat renal interstitial fibroblasts in vitro.Methods Rat renal interstitial fibroblasts isolated from normal SD rat renal medulla were cultured in vitro.The cells were divided into three groups:different concentrations of ACT-A(group A),different concentrations of FS(group F),and different concentrations of FS plus 30ng/ml ACT-A(group A+F).The expression of Col I mRNA in cultured rat renal interstitial fibroblasts was detected by RT-PCR,and the expression of Col I protein in cultured rat renal interstitial fibroblasts was examined by immunocytochemistry.Results Renal interstitial fibroblasts were successfully cultured in vitro.In present study,the expression of Col I mRNA increased significantly in cultured rat renal interstitial fibroblasts after stimulated by ACT-A in dose-dependent manner(P0.05).FS could inhibit the effects of ACT-A(30ng/ml) on Col I mRNA and Col I protein of the cultured renal interstitial fibroblasts in dose-dependent manner in A+F group(P

Objective:To investigate the change and related factors of nitric oxide,nitric oxide synthase level and cerebral blood flow(CBF) in panic disorder.Methods:30 patients with panic disorder,30 patients with generalized anxiety disorder and 22 normal controls entered the study.Serum level of NO and NOS were assayed.Cerebral blood flow were measured with TCD.Results:The concentration of NO was significantly lower in panic disorder group in comparison with GAD group.There was no significant difference in NOS level between panic disorder group and the control group.Cerebral blood peak flow velocity in the left and right middle cerebral artery and mean cerebral blood flow velocity in the right middle cerebral artery were lower than normal control group and the difference were very significant.Cerebral blood peak flow velocity in the right vertebral artery was lower than those of GAD and NC group.The concentration of NO in panic disorder was correlated with HAMA score negatively.Cerebral blood peak flow velocity in the left middle cerebral artery was correlated with mean Cerebral blood flow velocity in the left middle cerebral artery,peak CBF velocity in the right middle cerebral artery and psychological anxiety positively and correlated to cerebral blood peak mean velocity in the right middle cerebral artery,peak CBF velocity in the right anterior cerebral artery,age and female negatively.Cerebral blood peak flow velocity in the right middle cerebral artery has positive correlation with mean cerebral blood flow velocity in the right middle cerebral artery and peak CBF locity in the right anterior cerebral artery and negative correlation with cerebral blood mean flow velocity in the right anterior cerebral artery. Mean cerebral blood flow velocity in the right middle cerebral artery was correlated to cerebral blood peak flow velocity in the right middle cerebral artery,mean cerebral blood flow velocity in the left middle cerebral artery,cerebral blood mean flow velocity in the right anterior cerebral artery and NO level positively and age,cerebral blood peak flow velocity in the left middle cerebral artery and cerebral blood peak flow velocity in the right anterior cerebral artery negatively.Cerebral blood peak flow velocity in the right vertebra artery has positive correlation with cerebral blood mean flow velocity in the right vertebra artery and cerebral blood mean flow velocity in the left middle cercbral artery and negative correlation with cerebral blood peak flow velocity in the left anterior cerebral artery and cerebral blood mean flow velocity in the right anterior cerebral artery.Conclusion:The change of NO and cerebral blood flow may be one of the neurobiological mechanisms in panic disorder.To assay the level of NO and measure cerebral blood flow might become approach of diagnosis for panic disorder.

Objective To develop a new method with using surgical procedures for multiple correction of nasal deformity with cleft lip and palate.Methods Our operation procedures included elevation of the nasal floor depression in cleft side with the transplantation of autogenous cancellous bone, frustration and elevation of the nasal bone and part of the frontal process of maxilla, and replacement of septum between alar cartilages.Through these procedures, the nasal deformity could be multiply corrected.Results Postoperative follow up for 1～8years in 45 patients demonstrated satisfactory results. Conclusion Multiple correction is a new method of treatment for nasal deformity with cleft lip and palate.

Objective To evaluate safety and effect of percutaneous balloon mitral valvuloplasty(PBMV) for patients with rheumatic mitral stenosis and left atrial thrombi.Methods PBMV was performed in 27 patients with rheumatic mitral stenosis and left atrial thrombi. 19 cases of left atrial fresh thrombi revealed by transesophageal echocardiography (TEE) received warfarin orally for 3-6 months before PBMV. Results PBMV was successful in all cases of mitral stenosis and left atrial thrombi. Left atrial fresh thrombi was completely resolved in 9 cases and became smaller chronic organized thrombi in 10 cases after warfarin anticoagulation treatment among 19 cases of left atrial fresh thrombi revealed by TEE. In 5 cases of left atrial chronic organized thrombi shown only transthoracic echocardiography and without anticoagulation treatment, one case had cerebral embolism. No complication occurred in other cases.Conclusions The study showed that patients with rheumatic mitral stenosis and atrial fibrillation should have routine TEE. PBMV for rheumatic mitral stenosis with left atrial thrombi after anticoagulation treatment is safe and effective.

BACKGROUND: Research has proved that nifedipine can improve the functions of vascular endothelial cells. However, it still needs further study on its mechanism on dilating vessels.OBJECTIVE: To observe the effects of controlled-release nifedipine to nitrogen monoxide(NO) and induced nitric oxide synthase(iNOS) in spontaneously hypertensive rats(SHR).DESIGN: Comparative observational study based on experimental animals.SETTING: Experimental animal centre in a medical college.MATERIALS: This study was completed in Experimental Animal Centre of Shandong University during April to May 2002. Twenty-one recombinant inbred rats of clean class with body mass of(300 ± 2) grams were provided by Experimental Animal Centre of Shandong University. They were randomly divided into three groups: control group, normal group and low dose group,each with 7 rats.METHODS: Saline(10 mL/kg), 10 mL/kg and 3 mL/kg controlled-release nifedipine solution(0. 3 g/L) were poured into stomach to rats in control group, normal dose group and low dose group once everyday for 15 days respectively. Eyeball was removed to collect blood and heart and lung were removed at the same time to test the content of NO and iNOS in serum after last administration.MAIN OUTCOME MEASURES: Content of NO, comparison of iNOS activity between groups.RESULTS: There was significant difference on NO content between normal dose group and control group, low dose group after 15 days' administration ( P < 0. 01 ) . Compared with control group and low dose group, there was significant difference on the iNOS activity in heart and lung of normal dose group(P <0.01, P <0.05).CONCLUSION: While nifedipine reduces the blood pressure, it can also improve the content of NO and resist the increasing activity of iNOS casued by increased blood pressure.