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Objective To explore the value of the variation of clinical pulmonary infection score (CPIS) and serum procalcitonin (PCT) in diagnosis and treatment evaluation in patients suffering from active pulmonary tuberculosis with complication of ventilator-associated pneumonia (VAP).Methods A retrospective analysis was carried out in 58 VAP patients from June 1,2009 to December 30,2014 in the respiratory intensive care unit.According to the patient suffering from tuberculosis or not,patients were divided into two groups.The PCT and CPIS score changes were observed in the two groups of patients with intra-tracheal intubation 1,3 and 7 days after VAP onset.Comparisons of CPIS and PCT scores were carried out between two groups at different intervals after VAP onset.Data were statistically processed by SPSS 19.0.Count data were tested by x2,and measurement data were expressed by mean ± standard deviation (x-±s).The comparison within the groups was made by t test,whereas the comparison between the groups was by means of repeated measure analysis of variance and Bonferroni test;Pearson linear correlation analysis was used,and P ＜ 0.05 was considered statistically significant.Results At the same observation interval in two groups of patients with VAP,there was no significant difference in the serum levels of PCT and CPIS score (P ＞ 0.05);there were significant differences in PCT and CPIS scores between VAP occurred at the first day,the third day and at time of intra-tracheal intubation in two groups (P ＜ 0.05).However,comparison of PCT and CPIS scores at the seventh day,the differences were not statistically significant (P ＞ 0.05).In addition,at the 7 days the correlation coefficient between PCT and survival patients' mechanical ventilation,days in ICU and total length of hospital stay were 0.92,0.83,and 0.71,respectively,yet the 7-day CPIS score correlation coefficients were 0.83,0.74 and 0.70,(both P ＜ 0.05).Conclusions Early monitoring of serum PCT and CIPS score of pulmonary tuberculosis patients can judge the incidence of VAP,and the variations of PCT and CIPS score can predict the severity and prognosis of the disease as well.

Objective To investigate the clinical efficacy of pericardial devascularization (PCDV) combined with splenectomy and partial gsstric fundus resection (PGFR) in the treatment of portal hypertension-induced severe gastric varices complicated with gastrorenal shunt (GRS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with portal hypertension-induced severe gastric varices complicated with GRS who were admitted to the Fujian Provincial Hospital from January 2010 to December 2015 were collected.According to the stage of technical development,open surgery or laparoscopic surgery was selected based on patients' and their family's wishes.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival.The follow-up using outpatient examination and telephone interview was performed once every 3 months within 1 year postoperatively and once every 6 months after 1 year to detect long-term complications and survival up to June 2017.The reexaminations of gastroscopy,enhanced scan of X-ray computed tomography (CT) on the epigastric region or magnetic resonance imaging (MRI) were done at 1 month postoperatively for detecting resection of fundus ventriculi varicosity.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:18 patients underwent successful PCDV combined with splenectomy and PGFR,including 12 with open surgery and 6 with laparoscopic surgery (1 with conversion to open surgery due to intraoperatively uncontrollable bleeding).There was no perioperative death.The operation time,volume of intraoperative blood loss,recovery time of gastrointestinal function,time of postoperative drainagetube removal and duration of hospital stay were (192± 20) minutes,(280± 30) mL,(33 ±6) hours,8 days (range,5-9 days),8 days (range,5-12 days) in 12 patients with open surgery and (208±40)minutes,(210±10)mL,(28±5)hours,7 days (range,5-26 days),7 days (range,5-10 days) in 6 patients with laparoscopic surgery,respectively.One patient with laparoscopic surgery had intraoperative condensed erythrocyte infusion with 2 U.Seven,1,0 patients with open surgery and 4,1,1 patients with laparoscopic surgery were respectively complicated with pleural effusion,delayed gastric emptying and pancreatic leakage in level A,and they were cured by conservative treatment.(2) Postoperative pathological examination:results of postoperative pathological examination in 18 patients showed that a large number of varicose veins in the mucous and seresal layers of gastric fundus and moderate or severe hepatic cinr hosis.(3) Follow-up and survival:18 patients were followed up for 8-78 months with a median time of 39 months.The gastroscopy and enhanced scan of X-ray CT at 1 month postoperatively showed that no varicose veins in the gastric fundus.During the follow-up,there was no recurrence of gastric varices with GRS and esophageal stenosis.Of 4 patients with portal vein thrombosis,1 died of portal hypertensive gastropathy-induced upper gastrointestinal bleeding due to stop taking warfarin,and other 3 patients had portal vein patency by warfarin therapy.One patient was complicated with liver cancer at 32 months postoperatively and received radiofrequency ablation therapy.Two patients died,including 1 dying of hepatic failure at 35 months postoperatively and 1 dying of advanced liver cancer at 54 months postoperatively.The 1-,3-and 5-year overall survival rates of 18 patients were respectively 93.8％,84.4％ and 70.3％.Conclusion The PCDV combined with splenectomy and PGFR is safe and effective in the treatment of portal hypertension-induced severe gastric varices with GRS,with a dissemination value for appropriate patients.

Objective:To investigate the clinical efficacy of double-stitch full-layer pancreaticojejunostomy (DSFLPJ) in laparoscopic pancreaticoduodenectomy.Methods:The clinicopathological data of patients who underwent laparoscopic pancreaticoduodenectomy with DSFLPJ from Jan 2016 to Sep 2019 in Fujian Provincial Hospital were retrospectively analyzed.Results:Procedures were successfully performed in 82 patients. The average operation time was (321±55) minutes, among which the mean DSFLPJ time was (22±6) minutes. Intraoperative blood loss was (185±96) ml. Pancreatic fistula occurred in 11 patients, 7 with Grade A, 3 with Grade B and 1 with Grade C. The average postoperative hospital stay was (13±5) days. After the median follow-up of 9 months (1 to 44 months), two patients of pancreatic head cancer suffered recurrence.Conclusions:DSFLPJ is a safe and effective method in laparoscopic pancreaticoduodenectomy.