Objective To summarize the experience of laparoscopic cholecystectomhy(LC) in the treatment of acute cholecystitis in senile patients. Methods A retrospective review was made on 279 cases of LC in senile patients,involving 263 cases of acute calculous cholecystitis,8 cases of gallbladder adenoma,5 cases of polypoid gallbladder lesions,and 3 cases of acute cholecystitis with unknown causes.Out of the 279 cases,there were 25 cases of gallbladder hydrops accompanying stones impacted in the neck and 23 cases of atrophic cholecystitis. Results The success rate of LC was 87.5%(244/279),and LC was converted to open surgery in 35 cases.No serious complications or fatal cases happened. Conclusions For senile patients,acute cholecystitis is often complicated with other diseases,which increases peri-operative risks.To prevent and minimize the occurrence of complications,strict adherence to surgical indications,proper management of co-morbidities,and broadening indications of conversions to open surgery are all considered essential.

Objective To investigate the resting-state functional connectivity of the two hemispheres between multiple system atrophy (Parkinsonian type,MSA-P) and Parkinson's disease (PD).Methods A total of 25 MSA-P,29 PD patients and 29 well-matched healthy controls recruited in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from June 2013 to December 2015 were scanned with resting-state functional magnetic resonance imaging for voxel mirrored homotopic correlation (VMHC) analysis.The Mini Mental State Examination,Montreal Cognitive Assessment,Frontal Assessment Battery and Unified Parkinson's Disease Rating Scale-Ⅲ (UPDRS-Ⅲ) were used to assess the clinical symptom.Then the relationship between the change of VMHC values and severity of clinical symptoms was investigated.Results Compared with healthy controls,MSA-P and PD patients both showed decreased VMHC in bilateral cerebellum posterior lobe,precuneus gyrus,middle temporal gyrus,and postcentral gyrus.Compared with PD or healthy controls,MSA-P patients exhibited lower VMHC in bilateral putamen.Significant negative correlation between VMHC values of putamen and UPDRS-Ⅲ scores was found in MSAP patients (r =-0.607,P =0.001).Conclusion These functional changes suggest that the abnormal interhemispheric synchrony probably plays an important role in pathophysiology of both MSA-P and PD,and abnormal VMHC values in putamen of MSA-P may be helpful in differentiating MSA-P from PD.

Objective To explore the role of remote ischemic preconditioning(RIPC)in prevention of contrast -induced nephropathy(CIN)in elderly patients undergoing coronary artery angiography(CAA).Methods 106 elderly patients were enrolled in this randomized control trial.According to random number table,the patients were randomized into control group (n =53)and RIPC group(n =53).All of the patients received 1 000mL of 0.9% sodium chloride injection before CAA.The RIPC group patients underwent RIPC in their right arms with sphygmomanometer cuff infla-tion for 5 minutes prior to the CAA,three cycles were repeated.Serum creatinine was detected before and 48 hours after CAA.Results CIN was reported in 10 cases in the control group and 3 cases in the RIPC group(χ2 =4.30, P =0.04).The levels of serum creatinine were increased[(96.38 ±9.50)μmol/L vs (88.87 ±10.24)μmol/L] after CAA in the control group(t =2.28,P =0.03),and there was no difference in the RIPC group(t =1.17,P =0.24).Conclusion RIPC has a protective effect on CIN in elderly patients in our study.Since this method is harm-less and cost effective,further studies is required to popularize PIPC to our clinical practice for prevention of CIN.

Objective To study the diagnosis and treatment of synchronous gastric cancer and gastric stromal tumor in 18 cases. Methods Clinical data of 18 cases of synchronous occurrence of gastric cancer and gastric stromal tumor from January 1996 to December 2009 were analyzed retrospectively.Results Clinical features of all cases were atypical. There was 1 case diagnosed preoperatively, 3 cases diagnosed intraoperatively and 14 cases diagnosed postoperatively. The mean size of gastric cancer and gastric stromal tumor was (3.3±2.3) cm and (0.9 ±0.5) cm respectively. There were 16 cases of gastric stromal tumor in low risk of malignance and 2 cases in moderate risk of malignance. All cases were operated without complications and the 1-year, 3-year and 5-year overall survival rate was 88.2%, 63.2% and 36. 1% respectively. Conclusions Clinical features of synchronous occurrence of gastric cancer and gastric stromal tumor are atypical, in this series most gastric stromal tumors are in early stage and of low risk of malignance. The prognosis of patients with synchronous occurrence of gastric cancer and gastric stromal tumor mainly depends on gastric cancer.

ObjectiveTo explore the expression of Glut1, HIF-1α and Ki-67 in hepatocellular carcinoma (HCC) and their relationship between their expression and clinicopathological features.MethodsImmunohistochemical study (EnVision method) for Glut1, HIF-1a and Ki-67 were performed on tissue microarray which consisted of 171 cases of HCC, 55 cases of adjacent non-neoplastic liver tissues, and 22cases of normal liver tissues.ResultsThe expression rate of Glut1 ,HIF-1α and ki-67 in 171 cases of HCC was 15.2％, 19.9％ and 66.1％, respectively, which was much higher than that in the adjacent non-neoplastic liver tissues (1.8％ ,1.8％and 5.5％) and normal liver tissues(all negative).The expressions of Glut1 and HIF-1α were positively correlated with the differentiation degree of HCC and TNM stage(P ＜0.01, P ＜0.05).The expression of ki-67 was positively correlated with the differentiation degree of HCC.There was a significant positive correlation between the expressions of Glut1 and HIF-1α in HCC (r1 =0.553, P ＜0.05), the expressions of Glut1 and HIF-1α were positively correlated with ki-67(r2 =0.560,r3 =0.613, P ＜0.05).ConclusionsGlut1, HIF-1α and ki-67 may play a role in the tumorigenesis and progression of HCC in some degree.Combined detection of Glut1, HIF-1α and Ki-67 may be helpful to judge the degree of malignancy and potential metastasis and evaluate the prognosis.

Objective To investigate the impact of blood glucose level on the recurrence of liver cancer after laparoscopic surgery. Methods The clinical data of 98 patients with primary hepatocellular carcinoma from January 2012 to January 2015 were retrospectively analyzed. All patients were treated by laparoscopic radical resection of hepatocellular carcinoma. Patients were divided into elevated blood glucose group (n = 23) and control group (n = 75) according to whether the fasting blood glucose was ≥6.1 mmol/L. The recurrence of liver cancer in 1 year and 2 years after operation was compared. The factors influencing the recurrence of liver cancer were analyzed by univariate and multivariate analysis. Results The recurrence rates were 47.82% and 21.33% respectively in the patients with elevated blood glucose and the control group. The recurrence rates were 73.91% and 36.00%respectively in the 2-year postoperative patients with blood glucose and 1 year and 2 years. The recurrence rate was higher than that of the control group, the difference was statistically significant (P < 0.05). Logistic multivariate analysis showed that fasting blood glucose was high, Child-Pugh grade B, intraoperative blood transfusion, lymphatic invasion, high clinical pathology stage, postoperative alpha-fetoprotein (AFP) high, no postoperative adjuvant therapy (P < 0.05). Conclusion The recurrence rate of patients with elevated liver cancer after laparoscopic surgery is high, and fasting blood glucose is high, Child-Pugh grade is B grade, blood transfusion is high, there is lymphatic invasion, high clinical pathology stage after AFP high, no postoperative adjuvant therapy for its postoperative recurrence of risk factors, should strengthen the monitoring of high-risk patients, reduce postoperative recurrence rate.

Abstract: Objective　To understand the epidemiological characteristics of the migratory bird population with hypertension in Hainan and to provide a basis for the health management of the migratory bird population. Methods　One hundred and eighty migratory birds with hypertension who had lived in in the Mangrove Bay community of Chengmai, Hainan for 3 months or more were selected as the study population. Demographic data, including gender, age, ethnicity, occupation, medication use, family history of hypertension, hometown living environment, Hainan living environment (presence of water area and greenbelt around the residence, type of water area and greenbelt), smoking and alcohol consumption, and height and weight were collected by questionnaire and physical examination to investigate the epidemiological characteristics of the study subjects, and unconditional dichotomous logistic regression analysis was used to identify factors affecting the reduction of blood pressure among the hypertensive migratory bird population before and after taking medication in Hainan. Results　A total of 180 study subjects were included, including 77 (42.8%) males and 103 (57.2%) females, with 78 (43.3%) subjects aged ≤65. The hypertension levels were: 87 (48.3%) had normal high blood pressure, 56 (31.1%) had grade 1 hypertension and 37 (20.6%) had grade 2 hypertension. The higher the blood pressure classification, the lower the percentage of migratory individuals whose blood pressure dropped during their stay in Hainan. Age, hypertension classification, dietary habits, living environment, body mass index (BMI), and alcohol consumption were associated with a decrease in blood pressure during Hainan among the study participants who took hypertension medication regularly. Salty diet (OR=2.778, 95%CI:1.070-7.213, P=0.036) and alcohol consumption (OR=2.686, 95%CI:1.042-6.925, P=0.041) were unfavorable factors for lower diastolic blood pressure before taking medication; overweight (OR=3.487, 95%CI:1.306-9.310, P=0.013) was an unfavorable factor in the reduction of diastolic blood pressure after taking medication. Conclusion　The blood pressure reduction is more significant in migratory individuals in migratory individuals under 65 years old, with a light diet, no alcohol consumption and normal BMI. Environmental factors, age, dietary habits and lifestyle are the main causes of blood pressure, which can provide a reference basis for the health management of the migratory birds with hypertension in Hainan.

Objective:To explore the clinical manifestations, diagnosis and treatment methods, and prognosis of acute portal vein thrombosis after hepatectomy.Methods:Retrospective case analysis was used in the case data of 11 patients with acute portal vein thrombosis after hepatectomy, who were treated in Lishui Central Hospital of Zhejiang Province from January 2018 to August 2023, including their demographic characteristics, clinical manifestations, test results, imaging examinations, treatment plans, and prognosis.Results:The diagnostic time of PVT was 4-15 days after surgery. 5 cases were main portal vein thrombosis, including 2 cases who were accumulated splenic vein and superior mesenteric vein, and 6 cases were portal vein branch thrombosis. 2 cases had fever, 3 cases had abdominal distension, 3 cases had ascites, and 5 cases had no obvious clinical symptoms. Patients may experience elevated bilirubin, elevated transaminase, prolonged prothrombin time, and elevated D-2 dimer levels during PVT. 10 cases were diagnosed through CT enhancement, and 1 case was first diagnosed through ultrasound examination. 11 patients who diagnosed with PVT were received anticoagulant therapy, with 6 patients receiving a combination of circulatory improvement drugs. One patient progressed to liver failure, and 10 patients had thrombus disappearance, who were receivedsatisfactory clinical efficacy.Conclusions:Early detections and treatments are the key to treating the acute PVT after hepatectomy. If possible, anticoagulant therapy should be used as soon as possible after surgery. For main grade 3 portal vein thrombosis, early surgical thrombectomy should be considered. At present, there is a lack of effective prevention and prediction methods for acute PVTafter hepatectomy, and thefurther research and exploration are needed.

Objective To explore the effect of supplemental parenteral nutrition (SPN) combined with early enteral nutrition (EN) for enhanced recovery in postoperative liver cancer patients.Methods From June 2015 to June 2018,liver cancer patients admitted to our hospital were randomly divided into two groups with 47 patients receiving SPN combined with early EN in the study group and 45 patients receiving early EN in the control group.Results There were no significant difference in bilirubin recovery,liver enzyme recovery,postoperative exhaust and defecation time and complication rate between the two groups (P ＞ 0.05).In study group prealbumin (PAB) synthesis recovered faster (F =7.89,P =0.006),albumin use was significantly lower (t =-2.29,P =0.0024),and postoperative hospital stay was shorter (t =2.46,P =0.016).Conclusion In ERAS patients with liver cancer,the combination of SPN and early EN provide reasonable energy support to improve nutritional status and accelerate patient recovery.

Objective To explore the developmental characteristics of white matter volume in autism spectrum disorder (ASD) children longitudinal.Methods From May 2011 to September 2014,37 ASD children (ASD group)and 27 developmental delays (DD) children (control group) were treated at the Child Mental Health Research Center,Nanjing Brian Hospital Affiliated of Nanjing Medical University,and the children whose age,gender and developmental quotient matched with the ASD children were scanned by structure magnetic resonance imaging (sMRI) at the age of 2-3 years old and 4-5 years old respectively.Region of interest (ROI) technology was adopted to investigate the change of the cerebrum white and the sub-lobes structure white matter volume with time.Then the correlation between clinical symptoms and brain white matter volume changes was analyzed.Results Among the 2-3 years old,compared with the control group,the white matter volume of the total brain[(383 521.84 ±6 427.57) mm3 vs.(364 014.06 ±6 856.97) mm3],the left cerebral hemisphere [(191 609.35 ± 3 206.60) mm3 vs.(181 695.89 ± 3 389.54)mm3],temporal lobe [(41 860.49 ±816.38) mm3 vs.(39 444.18 ± 834.85) mm3] and the right temporal lobe [(21 312.79 ± 414.07) mm3 vs.(20 084.22 ± 412.13) mm3] were significantly larger in the ASD group,and the differences were statistically significant (all P ＜ 0.05).With the analysis of covariance with age or the total brain volume as the covariate,the differences disappeared(all P ＞ 0.05).Among the 4-5 years old,compared with the control group,the white matter volumes of the total brain[(417 651.42 ± 6 443.86) mm3 vs.(394 317.27 ± 6 404.86)mm3],left cerebral hemisphere [(208 714.16 ±3 214.61) mm3 vs.(197 192.82 ±3 262.02) mm3],right cerebral hemisphere [(208937.26±3242.09) mm3 vs.(7 124.45 ±3 193.13) mm3],frontal lobe [(107 107.46±1 681.99) mm3 vs.(100 326.19 ± 1 883.24) mm3],left frontal lobe [(54 569.63 ± 846.85) mm3 vs.(51 177.25 ±979.09) mm3],right frontal lobe [(52 537.83 ± 841.99) mm3 vs.(49 148.94 ±928.31) mm3],temporal lobe [(45 189.75 ± 833.29) mm3 vs.(42 487.73 ± 786.27) mm3],left temporal lobe [(22 204.21 ±411.77) mm3 vs.(20 922.90 ± 418.46) mm3],and right temporal lobe [(22 985.54 ± 426.93) mm3 vs.(21 564.83 ± 378.78) mm3]were significantly larger in the ASD group,and the differences were statistically significant (all P ＜ 0.05).With the analysis of covariance with age as the covariate,the differences still existed (all P ＜ 0.05).With the analysis of covariance with the total brain volume as the covariate,the differences disappeared (all P ＞ 0.05).For longitudinal analysis,there was a significant difference in the white matter volume between the whole brain,left cerebral hemisphere,right cerebral hemisphere,frontal lobe,left frontal lobe,fight frontal lobe,temporal lobe,left temporal lobe,right temporal lobe and the differences were statistically significant (F =5.521,5.533,5.459,5.830,5.800,5.723,4.857,4.418,5.159,all P ＜0.05).There was a positive correlation between the changes of the volume of whole brain,the white matter volume in the whole brain,bilateral cerebral hemisphere,frontal lobe,parietal lobe,right parietal lobe and Childhood Autism Rating Scale (r =0.367,0.343,0.321,0.349,0.296,0.308,0.351,all P ＜ 0.05).Conclusions Among the 2-3 years old,the white matter volume of the brain regions have been increased significantly in ASD.Among the 4-5 years old,the increase of the white matter volume of the brain regions implicated more widely which mainly concentrated in the frontal and temporal lobe in ASD.The severity of the clinical symptoms of ASD may be associated with the white matter volume of the total brain,bilateral cerebral hemisphere,frontal lobe,parietal lobe and right parietal lobe.