Objective To investigate the risk factors for nosoeomial pneumonia in elderly stroke patients(aged 60 years and over). Methods The clinical data of 259 patients with nosoeomial pneumonia from Jan 2002 to June 2007 were collected and the risk factors were retrospectively analyzed. Results The morbility rate of nosocomial pneumonia in elderly stroke patients was 41.3%,and the risk factors were aging,Iong hospitalization,unconsciousness,type of stroke,and underlying diseases,smoking,tracheal intubation,tracheotomy,application of respiratory machine (all P＞0.05). Conclusions The morbility rate of nosoeomial pneumonia in elderly stroke patients was high,and the risk factors are aging,long hospitalization,unconsciousness,type of stroke,and underlying diseases,smoking,tracheal intubation,tracheotomy,application of respiratory machine.

Objective To analyze the mierosurgery treatment and prognosis of cavernous hemangioma loca-ted in pons. Methods 12 cases with cavernous hemangioma located in ports underwent mierosurgery. 11 lesions lo-cated in dorsal tons were resected through midline suboccipital trans- rhomboid fnssa approach. 1 lesion located in ventrolateral pous was resected with suboceipital retrosigmoid approach. Results All the 12 cavernous hemangiomns were rosected totally and confirmed by the postoperative pathology. Clinical improvement was gained in 6 cases, no change in 3 ,aggravation of facial palsy in 1 ,death in 1. The mean follow-up time was 3 months,and Mill scan dem-onstrated good restoration of brain stem tissue with no recurrence signs of lesion. The symptoms due to the operation recovered to some extent. Conclusion The cavernous hemangioma located in brain stem can be resected safely and effectively given the selection of surgical indication and optimal surgical approach.

Objective To investigate hand hygiene status of health care workers (HCWs)in a hospital,and pro-vide guides for improving hand hygiene compliance.Methods Hand hygiene intervention was adopted in a hospital between 2012 and 2014,hand hygiene compliance among HCWs and healthcare-associated infection in patients be-tween August 1 and August 31 of each year were investigated and analyzed statistically.Results In 2102 -2014, hand hygiene compliance rate of HCWs was 59.55%,62.13%,and 65.16% respectively,which showed a increased trend (χ2 =10.018,P =0.002),HAI rate was 2.13%,1 .48% and 1 .06% respectively,which showed a decreased trend (χ2 =82.377,P <0.001 );hand hygiene compliance rate of doctors was lower than nurses (57.97% vs 65.97%);Of different hand hygiene moments,hand hygiene compliance rate was the lowest before touching a pa-tient(41 .32%),and highest after body fluid exposure (76.47%).Conclusion Comprehensive hand hygiene inter-vention in this hospital has achieved preliminary results,improvement of HCWs’hand compliance is helpful for pre-venting HAI.

Combined with the practice of curriculum reform in Xuzhou Medical College for for-eign clinical medical students, this paper discussed its experiences in compiling the teaching syllabus, programming rational courses, increasing practical class hours, establishing corresponding elective courses, taking various teaching methods and using flexible testing mode.

ObjectiveTo study the risk factors of renal artery pseudoaneurysm (RAP) following partial nephrectomy.MethodsOpen partial nephrectomy was performed on a total of 464 cases of renal cell cancer from July 2003 to May 2010. Five patients ( 1.1％ ) had postoperative hemorrhage from RAP.The surgery technique of the open partial nephrectomy, the clinical presentation, imaging findings and treatment of RAP were reviewed. The anatomical characteristics of these five renal tumors on enhanced CT were quantified using the R.E.N.A.L. Nephrometry Score System.ResultsAll five cases were male, two had tumors on the left side and three on the right side. Median tumor size was 3.6 cm ( range from 2.5 to 5 cm; Radius score 1 - 2). Four tumors were exophytic of these, three had a major endophytic component (≥50％) deep in the parenchyma (Exophytic/endophytic score 2 ), one was entirely endophytic (score 3 ). The distance of all the tumors to the collecting system was ≤4 mm ( Nearness score 3 ). Four of the five tumors were across the polar line and/or renal axial midline ( Location score 3 ). The other tumor was located under the lower pole ( Location score 1 ) but close to the renal hilar. All patients presented with delayed gross haematuria and decreasing hemoglobin occurred on mean postoperative day 12 (3 -23 day). Four patients complained of flank pain, two of which had signs of hypovolemia requiring blood transfusion. The diagnosis was confirmed by the contrast medium-enhanced CT and selective angiography, and RAP was found most commonly arising from the segmental branch of renal artery. Superselective microcoil angioembolization was successfully performed in four cases, once in three cases and twice in the remaining case. The procedure failed in one patient and a nephrectomy was done. At a mean follow-up of 21 months (12 -30) , all patients had normal renal function without evidence of recurrence.ConclusionsRAP should be considered in all patients who had delayed hematuria after partial nephrectomy. A central, deep tumor and its relationship to the segmental branch of renal artery could be an important risk factor for this complication. Choosing the case properly for partial nephrectomy and suturing the transected vessels and the defect of parenchymal correctly could reduce occurrence of this serious complication. Early use of selective angioembolization could be a primary choice of treatment.

Objective:To investigate the etiology, clinical manifestations, clinicopathological features of cystic neutrophil granulomatous mastitis (CNGM).Methods:From Jan 2019 to Dec 2020, 95 CNGM cases diagnosed by biopsy pathology at Chongqing Hospital of Traditional Chinese Medicine and Chongqing Liangping District Hospitol of Traditional Chinese Medicine were reviewed.Results:There were 95 female patients, aged 21 to 50 years, with a median age of 32 years. Laboratory examination showed that 56% (53/95) cases had elevated rheumatoid antibody level, 27 % (26/95) had increased level of serum thyroid antibody, 15% (14/95) had elevated antineutrophil antibody, 35% (33/95) had increased ESR, 38% (36/95) had increased C-reactive protein. The positive rate of Gram-stained bacilli was 82% (78/95). Histology: pyogenic granuloma with lobule of breast as the center, the center of granuloma was cystic vacuole.Immunohistochemistry showed that the inflammatory cells in and around granuloma were mainly CD3 + cells, and CD4 + cells were more than CD8 + cells. Conclusions:The cystic neutrophilie granulo matous mastitis is a rare type of idiopathic granulomatous mastitis. The diagnosis of CNGM is dependent on its specific pathological features.

The medical education model has undergone three transformations and is currently at the watershed of the fourth iteration.The intervention of artificial intelligence(AI)technology not only reshapes the medical model,but also has a significant impact on the medical education model,including ensuring that basic medical experiments are conducted safely and consistently,promoting the cultivation of students'diagnostic thinking ability,teaching according to their aptitude,cultivating personalized teaching plans,strengthening the humanistic care awareness of medical students,and promoting cooperation between clinical medicine and other social sciences.Meanwhile,medical AI also brings risks and challenges to teaching participants.Teachers and students need to strengthen communication,improve digital literacy,and ensure data security,while teachers need to encourage students to use technology reasonably and moderately,thus preventing them from getting lost in it.Medical colleges and universities need to maintain cooperation with various sectors of society,jointly face the ethical risks that have already arisen,and make up for the gaps in legal supervision.At the same time,the level of scientific and technological innovation should be strengthened,the talent training systems should be improved,and new talents who are in line with the direction of modern medical development should be cultivated.

Objective:To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods:The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 6 cases of chylothorax, 1 case of chylous ascites, and 3 cases of chylothorax combined with chylous ascites, respectively. Conservative treatment was invalid in all cases. The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography. Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted. The location of fistula was visualized by thoracic duct lymphangiography, and the embolization was performed by microcoils combined tissue adhesive agents. The post-operative curative effect and complications were recorded.Results:One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography; thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located. Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients. As for the other patient, after repeated failure of puncture, fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully. After the operation, the drain output was completely disappeared within 3 to 7 days in 8 patients, and decreased down to 120 ml/d in 1 patient. Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization, without any treatment. No serious complications was found in all cases.Conclusion:Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage, with a low complication rate.

Cholelithiasis is a kind of common and multiple diseases.In recent years,traditional laparotomy has been challenged by a minimally invasive surgery.Through literature review,the therapeutic method,effect,and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows.(1) For intrahepatic bile duct stones,the operation may be selected by laparoscopic liver resection,laparoscopic common bile duct exploration (LCBDE),or percutaneous transhepatic cholangioscopy.(2) For concomitant gallstones and common bile duct stones,the surgical approach can be selected as follows:laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation,LC plus laparoscopic transcystic common bile duct exploration,LC plus LCBDE,and T-tube drainage or primary suture.(3) For concomitant intrahepatic and extrahepatic bile duct stones,laparoscopic liver resection,choledochoscopy through the hepatic duct orifice on the hepatectomy cross section,LCBDE,EST,and percutaneous transhepatic cholangioscopic lithotripsy could be used.According to the abovementioned principle,the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.

Objective To study protective and therapeutic measures to improve perioperative safety in extremely elderly patients with biliary diseases.Methods A retrospective case-control study was conducted.The clinical data of elderly patients with biliary diseases treated at the Department of General Surgery,Beijing Electric Power Hospital,from July 2013 to December 2018,were collected.According to age,the patients were divided into the high age (HA) group (≥80.0 years) and the middle-low age (MLA) group (60.0～79.0 years).The related indexes of perioperative safety such as preoperative coexisting diseases,functions of liver,kidney,heart and lung,surgical procedures,intraoperative blood loss,operation time,postoperative hospital stay and postoperative hospital stay were analyzed and compared between the two groups.Results Of the 372 included patients,there were 168 males and 204 females,aged 60.0 to 96.0 (72.0 ± 8.6) years.There were 69 elderly patients (37 males and 32 females) aged 80.0 to 96.0 (84.4 ±3.8) years in the HA group.There were 303 patients in the middle and lower age group (131 men and 172 women),aged 60.0 to 79.0(68.4 ±5.8) years (MLA group).(1) Preoperative coexisting diseases were significantly increased in the HA compared with the MLA group (all P ＜ 0.05),including the proportion of coexisting coronary heart disease [34.8％ (24/69) vs.18.5％ (56/303)],hypertension [68.1％ (47/69)vs.46.9％ (142/303)],chronic bronchitis with emphysema [17.4％ (12/69) vs.3.6％ (11/303)],hypoproteinemia [39.1％ (27/69) vs.26.7％ (81/303)],and anemia [42.0％ (29/69) vs.11.9％ (36/303)].(2) Laboratory examinations:the functions of liver,kidney,heart,lung and blood coagulation were significantly worse in the HA compared with the MLA group (P ＜ 0.05).(3) Surgical procedures:the proportion of open cholecystectomy with transcystic common bile duct exploration (OC + OTCBDE) was higher [17.4％ (12/69) vs.6.9％ (21/303)],while laparoscopic cholecystectomy (LC) was lower [43.5％ (30/69) vs.62.7％ (190/303)],in the HA compared with the MLA group (P ＜0.05,totally).(4) Operative effects:the intraoperative blood loss [30.0 (20.0,75.0) ml vs.20.0 (10.0,30.0) ml],operation time [90.0(72.5,137.5) min vs.77.0(55.0,115.0) min],postoperative hospital stay [10.0(6.0,18.0) d vs.7.0(4.0,11.0) d],and length of hospitalization [17.0(11.5,23.0) d vs.13.0(9.0,19.0) d] were significantly increased or prolonged in the HA compared with the MLA group (all P ＜0.05).(5) Postoperative complications:the incidence of postoperative complications was significantly higher [30.4％ (21/69) vs.12.2％ (37/303)] in the HA compared with the MLA group (P ＜ 0.05).(6) Therapeutic outcomes:there was a cure rate of 95.7％ (66/69) in the HA group,and 97.7％ (296/303)in the MLA group.No significant difference in the therapeutic effects was found between the two groups (P ＞ 0.05).Conclusions Operation in extremely elderly patients with biliary diseases is safe and feasible.The key is to take measures such as actively treating preoperative coexisting diseases,strictly mastering operative indications,reasonably selecting surgical procedures,accurately carrying out precise operation,strictly monitoring and dealing with intraoperative emergency,timely preventing and treating postoperative complications,and especially focusing on maintaining cardiopulmonary function during the perioperative period.