Objective:To investigate the application value of fusion indocyanine green fluorescence imagine (FIGFI) in laparoscopic common bile duct reexploration.Methods:The clinical data of 65 patients who underwent laparoscopic common bile duct reexploration at Henan Province People′s Hospital from Jan 2015 to Dec 2019 were collected. According to the operational manner, the patients were divided into the conventional laparoscopic group (control group, 35 patients) and the FIGFI laparoscopic group (study group, 30 patients). The intraoperative and postoperative data were analyzed.Results:Operation time, time to identify extrahepatic bile duct, intra operative blood loss, and conversion to open surgery were (195.7±9.2) min vs (147.2±9.3) min, (39.3±3.7) min vs (21.8±1.8) min, (203.2±34.6) ml vs (108.9±32.1) ml, 8 vs 1, between the control group and the study group, respectively ( P<0.05). Postoperative cholangitis, bile leakage, intra abdominal infection, pancreatitis, and hospital stay were 11vs 2, 9 vs 2, 8 vs 1, 8 vs 1, (13.5±0.9) d vs (7.4±0.9) d, between the control group and the study group, respectively ( P<0.05). There was no statistically difference in case of residual stones (5 vs 3) and gastrointestinal fistula (3 vs 1) between the control group and the study group, respectively ( P>0.05). Conclusions:FIGFI provides real-time visualization of the extrahepatic biliary tract while doing laparoscopic common bile duct reexploration.

Objective To elucidate the etiology feature of viral infection in hospitalized children with acute lower respiratory infection. Methods A total of 5 480 children with acute lower respiratory tract infection, hospitalized from September 2007 to September 2009, were studied. Nasopharyngeal aspirates were screened for 8 types of viruses by direct immunofluorescence (DIF) assay. Results At least one type of viral pathogen was detected in 2 710 out of 5 480 patients and the overall positive rate was 49.5%. The most common virus was RSV (51.1%), followed by hMPV (18.9%), PIVⅢ (12.5%), ADV (7.1%), IFA (4.7%), IFB (2.9%), PIV Ⅰ (1.5%) and PIV Ⅱ (1.2%). The positive rate was highest in children under 6 months (43.5%). The seasonal change of RSV, hMPV was more obvious. The peak of RSV, hMPV appeared in the winter and the spring. The prevalence of viral infection in children with pneumonia, bronchitis, asthmatic bronchitis, non asthmatic bronchitis and asthma were 47.4%、63.6%、 50.5%、 30.1% and 43.5% respectively. Conclusions Viruses are the main cause of lower respiratory tract infections in children, especially in infants and young children. RSV and hMPV were the most common viruses in these years.

Objectives To explore the humoral immunologic mechanisms of the susceptibility to invasive pneumococcal diseases (IPD) in asthmatic children. Methods Plasma samples were collected from 43 asthmatic and 20 non-asthmatic chil-dren. Anit-pneumococcal capsular polysaccharide (PPS)-IgG concentrations were measured by enzyme-linked immunosorbent assays. Results The mean concentrations of anti-PPS 14, 19A and 23F-IgG were signiifcantly higher in asthmatic children than in non-asthmatic children (P<0.05). The ratios of the asthmatic children who had anti-PPS 14, 19A and 23F-IgG concentrations higher than the protective antibody level (≥0.2 μg/ml ) were 100%for all the serotypes. Conclusions The immune responses of producing anti-PPS IgG to defense IPD were normal in asthmatic children. Asthmatic children may be more susceptive to pneumococcal infection or colonization than non-asthmatic children.

Objective To explore the efficacy of Chen's cholangiojejunostojmy for tumors around biliary-intestinal anastomosis.Methods The clinical data on 11 patients operated from Jan 2012 to Dec 2014 were retrospectively analyzed.Results All these 11 patients underwent Chen's cholangiojejunostomy.The postoperative liver function significantly improved,and the symptoms of jaundice completely disappeared after operation [ALT (182.0 ±110.6) U/L vs (68.3±33.3) U/L,TBil (316.9 ±153.9) μmol/L vs (60.3 ± 25.8) μmol/L,DBil (184.1 ± 89.6) μmol/L vs (28.6 ± 12.4) μmol/L,P ＜ 0.01;AST (195.5 ± 206.9) U/L vs (48.6 ± 21.2) U/L,GT (806.7 ± 480.0) U/L vs (204.0 ± 99.1) U/L,ALP (612.8 ±424.6) U/L vs (277.5 ± 68.7) U/L,P ＜ 0.05].The level of CA19-9 also significantly decreased [(1 369.75 ± 1 812.18) kU/L vs (71.0 ± 46.5) kU/L,P ＜ 0.05].There were no significant differences in the CA125,CA15-3,CEA levels [CA125 (35.3 ± 26.0) kU/L vs (29.4 ± 23.5) kU/L,CA15-3 (19.4±12.3) kU/L vs (17.9±10.7) kU/L,CEA (8.4 ±7.7) μg/L vs (7.8 ±6.6) μg/L,P ＞ 0.05].There was no perioperative death.All the patients had a smooth perioperative recovery,except in 1 patient who developed bile leakage and another patient who had episodic attacks of cholangitis.There were no recurrent or metastatic tumors detected on follow-up.Conclusion Chen's cholangiojejunostomy was effective in the treatment of bile duct obstruction caused by tumors around biliary-intestinal anastomosis.

Objective The purpose of this study is to select suitable ages of rats for the CPR ( cardiopulmonary resuscitation) animal model.The neurological function score and subgroups analysis are evaluated in 2 month old and 4 month old animal groups.Methods Based on the evaluation of physiological indexes including ECG, blood pressure and neurological function defect score ( NDS) and subgroup analysis, the stability of CPR rats model was compared between 2 month old and 4 month old animal groups.Results The results showed that, the model rate of the ventricular fibrillation was induced by electrical stimulation , the 4 month old group was 87.5%, significantly higher than the 2 month old group, however, there was no significant difference between the two groups in the mortality rate;For the changes of blood pressure during the process of CA( cardiac arrest) induced by electrical stimulation, the 4 month old group was significantly lower than the 2 month old group (P <0.01); for the NDS at each time point after CPR, there was no significant difference between the two groups; however, the NDS subgroup analysis at different time points showed that there were different degrees of differences between the two age groups ( P <0.05) .Comparing with the 2 month old group, the 4 month old group had a stable process during the animal model preparation, had an obvious cerebral blood hypoperfusion phenomenon and aggravation of brain injury after CPR.Conclusion The 4 month old rats are more suitable for preparation of CPR animal mode , the model rate is high, the brain injury aggravate.It is more suitable evaluation for basic research and treatment of CPR.

Objective To study the distribution of rs2234693 and rs9340799 of estrogen receptor (ER)gene and the relationship between them and lipid metabolism in the Ningxia Hui group,China.Methods We used cluster sampling method to select 5 3 3 cases of Ningxia Yinchuan communities of Hui. SNP genotyping was performed using the Sequenom MassARRAY platform.Results ① The frequencies of the distribution of each genotype of rs2234693 in Ningxia Hui population were the same as those in Chinese Han and Dai,Americans, Europeans,and Japanese (P>0.05).The distribution of each genotype of rs9340799,especially AA genotype,was different from that in Europeans (P<0 .0 5 ).② The body mass index in dyslipidemia group was significantly different from that in the control group (P<0.01).③ The risk of dyslipidemia in subjects with GG genotype of rs9340799 was 2.97 times higher than that in subjects with other genotypes (OR=2.97,P<2.97 ).After adjustment of gender,age,and body mass index (BMI),estrogen level was also 2.76 times higher (OR=2.76,P<0.05).(4)The frequency of C-G in rs2234693-rs9340799 haplotype was greater than that in the control group,but without any significant difference (P>0.05).Conclusion ER genes distribution in the Hui nationality of Ningxia is significantly different from that in other races;rs2234693 has no obvious relationship with the occurrence of dyslipidemia while GG genotype in SNP rs9340799 significantly increases the risk of lipid metabolism disorders.

Objective To study the association of the CAG repeat length polymorphism in exon 1 of the androgen receptor (AR) gene with metabolic syndrome (MS) and its components in men.Methods We used cluster sampling method to select 910 middle-and old-aged male subjects from the communities in Yinchuan and Wuzhong cities,Ningxia.Their body height,weight and blood pressure were measured;their testosterone (TT),serum lipids,fasting glucose (FBG) and fasting insulin (FINS) were assayed;and their body mass index (BMI) and free testosterone (FT) were calculated.Length of CAG repeats in exon 1 of the AR gene was determined by polymerase chain reaction (PCR) and direct sequencing method.The subjects were divided into MS group (n =304) and normal control group (n=606) according to the diagnosis standards of MS.Results No obvious difference in the frequency distribution of CAG repeats in the AR gene was found between MS group and normal control group.The systolic blood pressure in the mcn with CAG repeat number of less than 22 was significantly higher than that in those with CAG repeat number of 22 or more,but HDL-C was significantly lower than men with CAG repeat number of 22 or more.However,the two groups did not significantly differ in diastolic blood pressure,other blood lipids level,FBG,FINS,BMI,TT or FT.The men with CAG repeat number of less than 22 had a higher prevalence of hypertension than those with CAG repeat number of 22 or more,but the prevalence of MS and other components of MS in the two groups had no significant difference,Conclusion The length of CAG repeats in exon 1 of the AR gene is related to the occurrence of hypertension and the dccreased level of HDL-C,but not to the incidence of MS.The number (less than 22) of CAG repeats of the AR gene may be a genetic factor of the occurrence of hypertension and reduced level of HDL-C.

Objective: To investigate the clinical efficacy of enhanced recovery after surgery(ERAS) in atrial caval shunting (ACS) for type Ⅱ Budd-Chiari syndrome(BCS). Methods: The clinical data of patients underwent ACS for type Ⅱ BCS in the Henan Province People′s Hospital from January 2014 to June 2016 were prospectively analyzed.Randomized and single-blind, controlled study was performed among the patients, and all of them underwent ACS and were divided into control group (patients underwent traditional perioperative management) and ERAS group (patients underwent ERAS perioperative management) based on a random number table.Operational and postoperative data, levels of inflammatory cytokines, stress state evaluation and postoperative complications were observed.The comparison between the two groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact. Results: Eighty-two patients were screened for eligibility, and allocated into the control group (40 patients) and the ERAS group (42 patients). All patients underwent ACS successfully with no death.Comparison of intraoperative status: operation time, volume of intraoperative blood and number of patients receiving blood transfusion were (211.0±12.9) minutes vs. (207.7±10.7) minutes, (167.5±28.3) ml vs. (165.0±28.4) ml and 3 cases vs. 1 case between the control group and the ERAS group, respectively, showing no difference between the two groups (t=0.90, 0.29, χ²=0.32, all P>0.05). Comparison of postoperative status: time of gastric tube removal, time of catheter removal, time of chest tube, time to flatus, time of food intake, duration of postoperative infusion, duration of postoperative hospital stay and numeric rating scale were (3.7±0.5)days vs. (0.0±0.0)days, (2.3±0.7)days vs. (1.4±0.5)days, (3.7±0.7)days vs. (2.3±0.5)days, (75.2±3.8)hours vs. (46.6±4.2)hours, (75.7±4.7)hours vs. (21.4±2.1)hours, (10.0±1.0)days vs. (5.8±0.9)days, (11.4±1.0)days vs. (7.8±0.6)days, 2.9±0.4 vs. 1.9±0.6 between the control group and the ERAS group, respectively, with statistically differences (t=35.03, 4.36, 8.10, 22.89, 47.78, 14.75, 14.22, 6.13, all P<0.05). Stress state evaluation: the levels of IR were (2.7±0.1) vs.(2.7±0.1), (8.8±0.7) vs. (5.2±0.3), (11.0±0.5) vs. (7.3±0.5), (4.9±0.2) vs. (3.9±0.1), and the levels of C-reaction protein were (14.6±1.3)mg/L vs.(14.6±1.1) mg/L, (101.2±13.6) mg/L vs. (89.5±6.9) mg/L, (62.7±8.6) mg/L vs. (56.4±8.4) mg/L, (46.4±6.7) mg/L vs. (40.0±5.6) mg/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends(F=136.61, 4.97, both P<0.05). Comparisons of levels of inflammatory cytokines: the levels of IL-6 were (43.1±2.7) ng/L vs. (43.6±3.6) ng/L, (135.1±6.4) ng/L vs. (117.4±5.7) ng/L, (145.4±6.7) ng/L vs. (128.5±5.5) ng/L, (93.3±3.7) ng/L vs. (88.0±3.9) ng/L, and the levels of TNF-α were (10.4±0.3)mmol/L vs. (10.4±0.3) mmol/L, (14.4±0.4) mmol/L vs. (12.6±0.4) mmol/L, (15.6±0.4) mmol/L vs. (13.8±0.4) mmol/L, (12.3±0.7) mmol/L vs. (11.4±0.6) mmol/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends (F=15.15, 21.45, both P<0.05). Comparison of postoperative complications: incidence of complications was 30.0%(12/40) in the control group and 11.9%(5/42) in the ERAS group, and the numbers of patients with nausea and vomiting, respiratory complications and cardiovascular complications were 4, 3, 5 cases in the control group and 3, 1, 1 case in the ERAS group, respectively, showing statistically differences in the incidence of complications(χ²=4.08, P<0.05). All the 82 patients were followed up for 2 to 22 months (median time, 12 months), no patients received reoperation or re-admitted to the hospital duo to complications. Conclusion ERAS management in the perioperative period of ACS for BCS is beneficial to postoperative recovery of patients, and can relieve postoperative stress state and inflammatory response, reduce the duration of hospital stay, and incidence of postoperative complications.

Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 25 patients with hilar cholangiocarcinoma who were admitted to Henan Provincial People′s Hospital from January 2017 to July 2019 were collected. There were 16 males and 9 females, aged from 51 to 75 years, with a median age of 64 years. All the 25 patients underwent laparoscopic radical resection of hilar cholangiocarcinoma. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using out-patient examination and telephone interview was performed to detect local recurrence and distant metastasis of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: of the 25 patients, 15 patients in Bismuth typeⅠunderwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ Roux-en-Y choledocho-jejunostomy, 2 patients in Bismuth type Ⅱ underwent laparoscopic radical resection of hilar cholangiocarcinoma+ perihilar resection+ regional lymph node dissection+ Roux-en-Y choledochojejunostomy, 2 patients in Bismuth type Ⅲa underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ right hemihepatectomy+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy, 3 patients in Bismuth type Ⅲb underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ left hemihepatectomy+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy, 3 patients in Bismuth type Ⅳ underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy. The operation time was (388±118)minutes, and volume of intraoperative blood loss was 200 mL(range, 50-2 000 mL). Six patients were treated with blood transfusion intraoperatively. The operation time of 2 patients in Bismuth type Ⅲa was 375 minutes and 465 minutes, and the volume of intraoperative blood loss was 200 mL and 1 000 mL, respectively; 1 case received blood transfusion. The operation time of 3 patients in Bismuth type Ⅲb was 410 minutes, 465 minutes, 501 minutes, and the volume of intraoperative blood loss was 300 mL, 400 mL, 450 mL, respectively; neither had intraoperative blood transfusion. The operation time of 3 patients in Bismuth type Ⅳ was 415 minutes, 560 minutes, 600 minutes, and the volume of intraoperative blood loss was 300 mL, 600 mL, 800 mL, respectively; 1 case had intraoperative blood transfusion. (2) Postoperative situations: of the 25 patients, 4 patients had grade Ⅰ complications, including 2 cases of biliary fistula (1 case in Bismuth type Ⅰ and 1 case in Bismuth type Ⅲa), 1 case of pulmonary infection (Bismuth type Ⅳ), and 1 case of postoperative liver insufficiency (Bismuth type Ⅲa), all of them were improved after conservative treatment. Results of postoperative pathological examination: bile duct adenocarcinoma and high-grade intraepithelial neoplasia were detected in 23 and 2 patients; there were 8 cases with nerve invasion, 3 cases with lymph node metastasis and no vascular thrombus. The duration of hospital stay and hospitalization expenses were 24 days (range, 10-45 days) and 9.4×10 4 yuan [range, (5.3-18.7)×10 4 yuan] for all the 25 patients; the above indicators were 36 days, 45 days, 15.1×10 4 yuan, 18.7×10 4 yuan for the 2 patients in Bismuth type Ⅲa, 15 days, 26 days, 33 days, 7.3×10 4 yuan, 11.5×10 4 yuan, 15.9×10 4 yuan for 3 patients in Bismuth type Ⅲb, 24 days, 39 days, 41 days, 12.1×10 4 yuan, 15.2×10 4 yuan, 16.7×10 4 yuan for the 3 patients in Bismuth type Ⅳ, respectively. (3) Follow-up: 25 patients were followed up for 2-36 months, with a median follow-up of 16 months. Of the 25 patients, 18 had no recurrence or metastasis, 2 patients in Bismuth type Ⅳ had extensive intraperitoneal metastasis, 1 patients in Bismuth type Ⅲa had trocar hole metastasis, and 4 patients died. Conclusions:Laparoscopic radical resection of hilar cholangiocarcinoma is safe and feasible. Surgeries should be selected strictly based on surgical indications and the Bismuth type.

Objective To explore the effects of morroniside on the expression of CD34 in ipsilateral cortex of rats after focal cerebral isch-emia-reperfusion. Methods 45 male Sprague-Dawley rats were divided into sham group (n=9), ischemia group (n=9), and morroniside groups (low, medium and high dosage groups, n=9). The middle cerebral artery were occluded for 30 minutes, and reperfused. Morroniside was administered intragastrically once a day at dose of 30 mg/kg, 90 mg/kg, 270 mg/kg after operation. The expression of CD34 in the isch-emic ipsilateral cortex were detected with immunohistochemistry (n=6) and Western blotting (n=3) 7 days after operation. Results The ex-pression of CD34 increased in the ischemia group compared with the sham group, and further increased in the morroniside groups of high dos-age compared with the ischemia group (F>14.865, P<0.001). Conclusion Morroniside could increase the expression of CD34 in the ischemic ipsilateral cortex after ischemia-reperfusion in rats, which may promote the angiogenesis and neurogenesis after ischemia.