Objective　To analyze the clinical features, etiological examination, laboratory examination, imaging examination, and treatment of patients with diabetes combined with Klebsiella pneumoniae liver abscess (KPLA), and to provide a reference for clinical work. Methods　The clinical data of patients with diabetes combined with KPLA in the First People's Hospital of Neijiang City from 2021 to 2022 were retrospectively analyzed. Results　Among the 12 patients with diabetes combined with KPLA, there were 8 males and 4 females, aged 47-74 years old. Five cases were combined with biliary tract diseases, 3 cases were combined with syphilis, and 2 cases were combined with hepatitis B.The main clinical manifestations included fever (12 cases), anorexia (10 cases), stomachache (6 cases), dizziness (2 cases), weakness (3 cases), cough and sputum (2 cases), disturbance of consciousness (2 cases), and visual impairment (1 case). Laboratory test results showed an increase in the percentage of neutrophils, glycosylated hemoglobin, transaminase, C-reactive protein, and procalcitonin, as well as a decrease in platelets and albumin. Abdominal CT findings were predominantly unilateral lesions, mostly found in the right liver, mainly manifested as mass, flaky, and nodular shadows. Two patients presented with invasive syndromes, 2 cases had lung abscesses, and 1 case had concomitant endophthalmitis and meningitis. The etiological examination of 12 patients with Klebsiella pneumoniae showed that they were all sensitive bacteria. After actively controlling blood glucose, effectively using antibiotics, and performing liver puncture and drainage, 11 cases improved, while 1 case was left with permanent blindness. Conclusions　The clinical features of diabetes combined with KPLA are atypical and easy to misdiagnose, thus early imaging and etiological examination should be performed. Aggressive glucose control, and selection of sensitive antimicrobial drugs based on drug sensitivity tests combined with liver abscess puncture and drainage can help to improve the prognosis.

Objective To evaluate the mid‐term efficacy of microendoscopic discectomy (MED) and microsurgical lumbar discectomy (MSLD) for treating lumbar disc herniation (LDH) .Methods 98 patients with single segment LDH in the Orthopedic department of the Second Hospital of Lanzhou University from March 2009 to April 2010 were divided into 2 groups ,including 44 cases undergoing MED and 54 cases undergoing MSLD .The operative efficacies were assessed by the visual analogue scale (VAS) , Japanese Orthopedic Association (JOA) scores and Oswestry Disability Index (ODI) .Results There were statistically significant differences in the skin incision length ,amount of intraoperative blood loss and time of returning to work between the two groups (P<0 .01) ,while the operation time ,average hospital stay time and incidence of complications showed no statistically significant differences (P>0 .05) .The mean follow‐up duration was 49 .13 months in the MED group and 47 .24 months in the MSLD group respectively .At the last follow‐up the postoperative back and leg pain VAS scores ,JOA scores and ODI in each group were signifi‐cantly improved compared with the preoperative data (P<0 .01) .However ,there were no statistically significant differences in the intergroup comparison .Conclusion MED and MSLD are the effective methods for treating single segment LDH .However ,MED has less trauma and early out‐of‐bed ambulation ,is an ideal minimally invasive surgery .

Objective To compare the clinical outcome of internal fixation(IF)and total hip arthroplasty (THA)for the elderly patients with displaced femoral neck fracture. Methods A total of 128 patients with dis-placed femoral neck fracture admitted from January 2010 to December 2012 were selected and divided into IF group(61 cases)and THA group(67 cases). The operation and hospitalization index were compared between the 2 groups. All patients underwent follow-ups after operation. The functional recovery scale for hip fracture (FRS) and EQ-5D index were applied to evaluate the clinical outcomes periodically. Results Compared to THA group, the intraoperative trauma ,operation time and bed days were less in IF group(P<0.05),however the incidence of complication in IF group was higher than that in THA group. All the patients were followed up more than 3 years and mortality rate between the 2 groups showed no significant difference(P>0.05). Follow-ups at all time points revealed hip function in THE group is better than that in IF group(P<0.05),while no significant difference was found in terms of life quality(P > 0.05). Within 3 years,the costs related to fracture were 41772 yuan for IF group and 61174 yuan for THA group respectively. Conclusion Both internal fixation and total hip arthroplasty can provide satisfactory outcome for elderly patients with displaced femoral neck fracture. Compared with IF ,THA causes bigger trauma and costs more ,but ends up with lower complication incidences ,and improve hip function in a shorter period.

Objective: To evaluate the effects of Liu Zi Jue Qigong (LQG)-based breathing training on the curvature and range of motion (ROM) of the thoracic and lumbar spines in different positions. Methods: Forty-seven college students were selected as subjects and randomly divided into an observation group and a control group. In the observation group, 27 subjects received regular LQG-based breathing training for 12 weeks, while 20 subjects in the control group did not receive any intervention. The spine measuring instrument Spinal Mouse was adopted to detect the curvature and ROM of the thoracic and lumbar spines. Results: In the observation group, the changes in the curvatures of thoracic spine in the upright and forward-bending positions showed statistical significance after LQG exercise (P<0.05), while there was no notable difference in the control group. The comparison of ROM of the thoracic spine from the upright position to the forward-bending and load-bearing positions showed statistically significant difference in the observation group (P<0.05), while there was no significant difference in the control group. There was no significant difference in the lumbar curvature and ROM in the two groups after LQG exercise. Conclusion: LQG-based breathing training improves the curvature and ROM of the thoracic spine.

Respiratory mucosal immune system is the body''s first line of defense against infection.Since the outbreak of novel coronavirus disease 2019 (COVID-19) in 2019,nasal mucosal immune vaccine, with its ability to induce cellular, humoral and mucosal triple immune responses, has become a research hotspot.This article focuses on novel coronavirus, with an understanding of its structure and pathogenesis, a brief introduction to the immune mechanism of nasal mucosa, a summary of the different types of nasal mucosal immune vaccines and their clinical research, aiming to provide some theoretical reference for the development of new vaccines, and exploration of the best methods and strategies to combat COVID-19.

Acromioclavicular joint dislocation is a common clinical condition in shoulder injuries, causing shoulder pain, swelling, and tenderness, and leading to limitations in abduction, elevation, forward flexion, and extension of the upper limb, which severely affects the patient′s daily life. Rockwood type ⅢB to type Ⅵ acromioclavicular joint dislocations, involving coracoclavicular ligament rupture, often require surgical treatment. Coracoclavicular fixation or ligament reconstruction, by reconstructing the coracoclavicular ligament, restores the vertical stability of the acromioclavicular joint and is more in line with the anatomical structure of the joint, which has been widely accepted by clinical physicians and patients. However, in recent years, there have been reports questioning its adequacy in horizontal stability. This article aims to review the treatment of acromioclavicular joint dislocations with coracoclavicular fixation and coracoclavicular ligament reconstruction and to discuss the future prospects of this approach.

Objective:To compare the efficacy of closed-loop target-controlled deep versus moderate neuromuscular blockade in gynecological laparoscopic surgery.Methods:This was a prospective study. Fifty American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective gynecological laparoscopic surgery in the General Hospital of Tianjin Medical University from March 2020 to March 2021, were allocated into 2 groups ( n=25 each) using a random number table method: closed-loop target-controlled moderate neuromuscular blockade group (group TOF) and closed-loop target-controlled deep neuromuscular blockade group (group PTC). Rocuronium was given by closed-loop target-controlled infusion in both groups. In group TOF, the target muscle relaxation was considered as train-of-four stimulation (TOF) of 1 or 2. In group PTC, the target muscle relaxation was considered as post-titanic count of 1 or 2. The score for operator′s satisfaction with muscle relaxation, grading, satisfaction rate, mean pneumo-peritoneum pressure, consumption of rocuronium, recovery index, recovery time to a TOF ratio 0.9 and time to extubation were recorded. The postoperative visual analogue scale score for abdominal pain and use of rescue analgesics were recorded, and the occurrence of complications such as shoulder pain, arm pain, nausea, vomiting and hypoxemia was also recorded within 48 h after surgery. Results:Compared with group TOF, the score for operator′s satisfaction with muscle relaxation, grading and satisfaction rate were significantly increased, the mean pneumo-peritoneum pressure was decreased, the total and average consumption of rocuronium was increased, the recovery time of a TOF ratio 0.9 was prolonged, and the postoperative visual analogue scale score for abdominal pain and usage rate of flurbiprofenate were decreased in group PTC ( P<0.05). There were no significant differences in the recovery index, tracheal extubation time or postoperative incidence of hypoxemia, shoulder pain, arm pain and nausea and vomiting between the two groups ( P>0.05). Conclusions:Compared with the closed-loop target-controlled moderate neuromuscular blockade, the closed-loop target-controlled deep neuromuscular blockade provides more satisfactory surgical conditions for gynecological laparoscopic surgery, decreases pneumoperitoneum pressure and reduces related complications, without increasing the development of postoperative adverse reactions.

Objective:To investigate the influencing factors for textbook outcome (TO) after hepatectomy for hepatolithiasis.Methods:The retrospective case-control study was conducted. The clinicopathological data of 216 patients with hepatolithiasis who were admitted to The First Affi-liated Hospital of Anhui Medical University from January 2015 to March 2023 were collected. There were 69 males and 147 females, aged 61(range, 22-85)years. Observation indicators: (1) treatment situations; (2) TO after hepatectomy; (3) Influencing factors for TO after hepatectomy. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Logistic regression models were used for univariate and multifactorial analyses. Results:(1) Treatment situations. All the 216 patients underwent hepatectomy, including 45 cases of laparoscopic hepatectomies and 171 cases of open hepatectomies, 161 cases of anatomical hepatectomies and 55 cases of non-anatomical hepatectomies. All the 216 patients underwent intraoperative choledochoscopy exploration and lithotripsy. There were 170 patients with normal Oddi sphincter function and 46 patients with Oddi sphincter dysfunction. All the 216 patients underwent biliary drainage, including 198 cases of external T-tube drainage and 18 cases of internal bile-intestinal drainage. The operation time was (226±75)minutes and volume of intraoperative blood loss was (106±82)mL. There were 29 patients with perioperative blood transfusion and 14 patients with intraoperative severe adverse events. There were 189 patients achieved immediate stone clearance. Of 183 patients with intraoperative bile cultures, 76 cases were positive for bacteria culture. (2) TO after hepatectomy. Of 216 patients, 93 cases had postoperative complications, all of which were successfully discharged after active treatment. One patient had surgery-related death within 90 days after surgery, and the cause of death was liver failure. Five patients were readmitted within 90 days after surgery, and 18 patients had postoperative stone residual. Of 216 patients, 164 cases achieved TO postoperatively and 52 cases did not achieve TO postoperatively. (3) Influencing factors for TO after hepatectomy. Results of multivariate analysis showed that cholangitis, stone distribution, surgical approaches, anatomical hepatectomy, immediate stone removal and postoperative review of choledochoscopy were independent influencing factors for TO after hepatectomy in patients with hepatolithiasis ( P<0.05). Conclusion:Cholangitis, stone distribution, surgical approaches, anatomical hepatectomy, imme-diate stone removal and postoperative review of choledochoscopy are independent influencing factors for TO after hepatectomy in patients with hepatolithiasis.

Objective:To establish a mortality risk prediction model of severe bacterial infection in children and compare it with the pediatric early warning score (PEWS), pediatric critical illness score (PCIS) and pediatric risk of mortality score Ⅲ (PRISM Ⅲ).Methods:A total of 178 critically ill children were selected from the PICU of the Children's Hospital of Nanjing Medical University from May 2017 to June 2022. After obtaining the informed consent of the parents/guardians, basic information such as sex, age, height and weight, as well as indicators such as heart rate, systolic blood pressure and respiratory rate were collected from all children. A standard questionnaire was used to score the child 24 h after admission to the PICU. The children were divided into the survival and death groups according to their survival status at 28 d after admission. A mortality risk prediction model was constructed and nomogram was drawn. The value of the mortality risk prediction model, PEWS, PCIS and PRISM in predicting the risk of death was assessed and compared using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).Results:Among the 178 critically ill children, 11 cases were excluded due to severe data deficiencies and hospitalization not exceeding 24 h. A total of 167 children were included in the analysis, including 134 in the survival group and 33 in the death group. A mortality risk prediction model for children with severe bacterial infection was constructed using pupillary changes, state of consciousness, skin color, mechanical ventilation, total cholesterol and prothrombin time. ROC curve analysis showed that the AUCs of mortality risk prediction model was 0.888 ( P<0.05). The AUCs of PEWS, PCIS and PRISM Ⅲ in predicting death in children with severe bacterial infection were 0.769 ( P< 0.05), 0.575 ( P< 0.05) and 0.759 ( P< 0.05), respectively. Hosmer-Lemeshow goodness-of-fit test showed the best agreement between risk of death and PEWS predicted morbidity and mortality and actual morbidity and mortality (χ 2 = 5.180, P = 0.738; χ 2 = 4.939, P = 0.764), and the PCIS and PRISM Ⅲ predicted mortality rates fitted reasonably well with actual mortality rates (χ 2= 9.110, P= 0333; χ 2 = 8.943, P= 0.347). Conclusions:The mortality risk prediction model for predicting the death risk has better prognostic value than PEWS, PCIS and PRISM Ⅲ for children with severe bacterial infection.

Objective: To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy. Methods: Literatures were researched using CNKI，CBM，Wanfang database，VIP databases，PubMed (Medline)，Embase，Web of science，Science Direct，Cochrane Center from January 1996 to March 2018 with the key words including "肝切除术，免疫营养，hepatectomy，hepatic resection，immunonutrition，immunoenhanced nutrition" . The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy. Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy，and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy. Outcome measures：overall incidence of postoperative complications，incidence of postoperative infectious complications，incidence of postoperative liver failure，perioperative mortality，hospital stay，and hospitalization expenses. Literatures screening，data extraction and quality assessment of methodology were conducted by two researchers separately. Count data were represented as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95%CI. Heterogeneity of the included studies was analyzed with I². Funnel plot was used to test potential publication bias if the number of studies included ≥ 10，and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included <10. Results: (1) Document retrival: 12 RCTs were enrolled in the Meta analysis, and the total sample size was 1 136 patients, including 568 patients in the immunonutrition group and in the routine nutrition group, respectively. (2) Results of Meta-analysis: the that immunonutrition group had lower overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and hospital stay (RR=0.57, 0.49, 0.30, MD=-3.28, 95%CI: 0.46-0.71, 0.37-0.65, 0.12-0.74, -4.45 to -2.11, P<0.05), and higher hospital expenses (MD=11.86, 95%CI: 10.96-12.77, P<0.05) compared with the routine nutrition group. There was no significant difference in the perioperative mortality between the two groups (RR=0.26, 95%CI: 0.07-1.05, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group, suggesting that publication bias had little influence on results of Meta-analysis. Conclusions Perioperative immunonutrition support for hepatectomy is safe and feasible. Compared with routine nutritional support, immunonutrition support can significantly reduce overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and shorten the hospital stay without increasing postoperative mortality.