Objective To analyze the risk factors that influence prognosis of pancreatic injury.Methods The clinical data of 73 patients with pancreatic injury were analyzed retrospectively.Univariate analysis and multivariate Logistic regression were performed to analyze the clinical parameters.Results Complications occurred in 27 patients with the overall incidence rate of 36.9％.6 patients died with the mortality of 8.2％.Result of univariate analysis indicated that the volume of blood loss,systolic blood pressure,injury grade by American Association surgery of Trauma (AAST),pancreatic leakage,time on admission were significant factors that influence the incidence rate of complications (P ＜ 0.05).The results of Multivariate Logistic regression indicated that the volume of blood loss,systolic blood pressure,injury grade by AAST,time on admission were independent predictors for prognosis in pancreatic injury (OR =3.764,0.940,7.315,1.501,all P ＜ 0.05).Conclusion It should pay attention to all the factors that influence the prognosis of pancreatic injury in clinic.Exact judgment and appropriate treatment plan are helpful to increase achievement ratio of pancreatic injury.

Objective To explore the risk factors of adhesive small bowel obstruction for the influence of the long-term therapeutic effects.Methods 218 case of adhesive small bowel obstruction in patients were treeted with a long follow-up and retrospective analysis.Results Among the 218 admissions in 235 patients,192 admissions (81.7.％) were surgical treated and 43 admissions(18.3％) were performed conservative treatment.The mean recovery time was 65.7 months and the accumulative incidence of surgical recurrence in 5 years was 19.0％ in surgical group and those in conservative group were 50.4 months and 34.0％ respectively.There was significant difference between two groups (P ＜ 0.05).Conclusion The long-term efficacy of risk factors was related to the treatment before the operation site and times,the last operation to the incidence of admissions.No other independent risk factor of recurrence was found.Surgical treatment serves as a better way in the prevention of later recurrences in patients with adhesive intestinal obstruction under certain conditions.

Objective To evaluate the value of contrast-enhanced ultrasound(CEUS) in diagnosis of placental increta.Methods Twenty seven suspected patients with placental increta were examined with CEUS after routine ultrasound examination.SonoVue was injected intravenously as bolus and a real time CEUS was performed.The characteristics of contrast perfusion was analysised.Results Among the three antepartum CEUS cases,two had a clear boundary between the placenta and uterine wall,there was no residual placenta after induced labor;one had a blur boundary between the local placenta and uterine wail,and the local placenta adherenced to the uterine wall tightly when cesarean section was performed after induction failure.Comparison between CEUS and uterine curettage in 20 cases,5 cases had a dear boundary between residual disease in uterine cavity and uterine wall.The boundary between residual disease in uterine cavity and uterine wall disappeared in other 15 cases.Four cases performed total and subtotal hysterectomy,the uterine myometrium of placenta affixing part were very thin (3 - 5 mm),and the boundary between the placenta and uterine wall disappeared,and placental increta was proved by intraoperative and pathology.Conclusions When the boundary between residual placenta and uterine wall disappeared and/or the local uterine wall became thin,placental increta was suggested intensively.

Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS) in the diagnosis of postnatal placenta increta. Methods Twenty-six patients with postnatal placenta increta were examined by gray-scale and color Doppler ultrasound and CEUS. Then microvascular perfusion and enhanced features of lesions, myometrium and serous layer were observed. Arriving time (AT), time to peak intensity (TTP) and the lasting time of enhancement (LTE) were recorded. AT,TTP and LTE of enhanced lesions were compared with those of normal myometrium. Results Serous layer, lesions and adjcent myometrium,normal myometrium enhanced in turn. There was no obvious boundary between the lesions enhanced and adjcent myometrium. AT and TTP of the lesions enhanced were both less than those of normal myometrium ( P ＜0. 05). LTE of the part of lesions enhanced was more than that of normal myometrium ( P ＜0.05).Part of lesions never enhanced during the whole process. The serous layer of uterine was smooth and uninterrupted in 24 patients. These 24 patients all recovered after conservative treatment. The local serous layer adjcent lesions was not smooth, but no contrast agent leakage occurred in another 2 patients, and uterine lobectomy were performed in emergency because of massive hemorrhage during conservative treatment. Conclusions Microvascular perfusion and enhanced features of lesions,myometrium and serous layer could be showed clearly through CEUS.

We report the implantation genetic testing and prenatal diagnosis of a family with neurofibromatosis type I (NF1). High-throughput sequencing combined with multiplex ligation-dependent probe amplification was performed to identify the pathogenic mutation sites, then verified by Sanger sequencing. The pathogenic mutation of c.4172G>C in the NF1 gene was found in the proband and his mother. After sequencing and single nucleotide polymorphism (SNP) haplotyping of the mutation sites in the embryos by establishing the SNP-linked haplotype, a well-developed blastocyst, without pathogenic mutations, was transplanted, and 28 d later, the ultrasound confirmed that the patient was pregnant. Amniotic fluid samples of the fetus were obtained at 19 +3 weeks for karyotyping and detection of the gene mutation site, which found the fetus did not carry the maternal c.4172G>C mutation of NF1 gene or any copy number variants of clear clinical significance. The patient delivered a healthy term girl by cesarean section, and no significant abnormalities were found during the follow-up to 10 months of age.

Objective:To study the changes and influencing factors of splanchnic regional saturation before and after feeding in preterm infants with feeding intolerance (FI).Methods:From December 2018 to August 2019, preterm infants with FI admitted to the neonatal intensive care unit of our hospital within 24 hours after birth were prospectively enrolled in this same-patient before-after study. Splanchnic regional saturation (rSsO 2) and cerebral regional oxygenation (rSc0 2) 5 minutes before feeding and 1 hour after feeding were monitored using near-infrared spectroscopy (NIRS). The average values of rScO 2, rSsO 2 and splanchnic-cerebral oxygenation ratio (SCOR) before and after feeding were calculated. The clinical data including postnatal age, corrected gestational age and feeding methods (breastfeeding or formula feeding) were collected. Single-factor correlation analysis and multiple linear regression were used to analyze the influencing factors of rSsO 2 before and after feeding. Results:A total of 41 preterm infants were included. No significant differences existed in rSsO 2, rScO 2 and SCOR before and after feeding ( P>0.05). The feeding methods showed relative prominent influences on the changes of rSsO 2 and SCOR before and after feeding. The breastfeeding infants had smaller changes of rSsO 2 and SCOR before and after feeding compared with formula feeding infants, the regression equations were Y=5.538-4.065X (model complex correlation coefficient was 0.414 determination coefficient R2=0.171, F=8.050, P<0.01) and Y=0.109-0.075X (model complex correlation coefficient was 0.405 determination coefficient R=0.1642, F=7.655, P<0.01). Conclusions:Proper feeding will not increase rSsO 2 in preterm infants with FI. Comparing with formula feeding infants, breastfeeding infants has more stable post-feeding rSsO 2.Breastfeeding should be the first choice for preterm infants with FI.

Objective To evaluate the risk factors and sonographic findings of pregnancies complicated by placenta increta or placenta percreta. Methods Totally, 2219 cases were retrospectively analyzed from 20 tertiary hospitals in China from January 2011 to December 2015. The data were collected based on the original case records. All cases were divided into two groups, the placenta increta (PI) group (79.1％, 1755/2219) and the placenta percreta (PP) group (20.9％, 464/2219), according to the degree of placental implantation. The risk factors and sonographic findings of placenta increta or percreta were analyzed by uni-factor and logistic regression statistic methods. Results The risk factors associated with the degree of placental implantation were age, gravida, previous abortion or miscarriage, previous cesarean sections, and placenta previa (all P<0.05), especially, previous cesarean sections (χ2=157.961) and placenta previa (χ2=91.759). Sonographic findings could be used to predict the degree of placental invasion especially the boundaries between placenta and uterine serosa, the boundary between placenta and myometrium, the disruption of the placental-uterine wall interface and loss of the normal retroplacental hypoechoic zone(all P<0.01). Conclusions Previous cesarean sections and placenta previa are the main independent risk factors associated with the degree of placenta implantation. Ultrasound could be used to make a prenatal suggestive diagnosis of placenta accreta spectrum disorders.

Objective:To evaluate the predictive value of mechanical power (MP) on the risk of in-hospital mortality in critical ill patients in emergency department.Methods:A total of 105 critical ill patients with invasive mechanical ventilation in the Department of Emergency of Second Affiliated Hospital of Guangzhou Medical University between December 1, 2017 and October 31, 2020 were retrospectively analyzed. Based on the clinical prognosis, the patients were divided into the in-hospital survival group (80 patients) and the in-hospital death group (25 patients). The clinical data and ventilator parameters were recorded, and the MP of the two groups was calculated in order to assess the predictive efficacy of MP on in-hospital death.Results:Compared to the in-hospital death group, the oxygenation index PaO 2/FiO 2 was significantly higher (271 mmHg vs. 217 mmHg, P=0.020) and blood lactate (1.59 mmol/L vs. 2.56 mmol/L, P<0.001) and procalcitonin (0.31 ng/mL vs. 3.55 ng/mL, P=0.028), minute ventilation (7.03 L/min vs.8.32 mmol/L, P=0.013), MP (14.37 J/min vs. 16.12 J/min, P=0.041), SOFA score (5 vs. 8, P=0.001) and APACHE II score (16 vs. 22, P=0.041) were significantly lower in the in-hospital survival group. Multivariate Logistic regression analysis showed that PaO 2/FiO 2( OR=1.015, P=0.044), MP ( OR=1.813, P=0.039) and SOFA score( OR=2.651, P=0.010) were independent risk factors for predicting hospital mortality in patients with mechanical ventilation. The areas under the ROC curves (AUC) were 0.62, 0.63 and 0.75, respectively. Moreover, the MP combined with SOFA score for predicting in-hospital death was significantly higher than that of MP alone (0.77 vs. 0.63, P<0.05). Conclusions:MP is associated with in-hospital death in patients with invasive mechanical ventilation in emergency department. MP combined with SOFA score can enhance its predictive efficacy

OBJECTIVETo observe the effect difference between fire needle combined with chemotherapy and fire needle on quality of life in patients with chemotherapy of non-small cell lung cancer (NSCLC).

METHODSWith randomized controlled method, a total of 60 patients with chemotherapy of NSCLC were divided into an observation group (fire-needle plus chemotherapy group) and a control group (chemotherapy group), 30 cases in each one. The observation group was treated with fire needle atpoints which consisted of Geshu (BL 17) and Danshu (BL 19), combined with chemotherapy selected from TP (paclitaxel+cisplatin)/GP (gemcitabine+cisplatin)/DP (docetaxel+cisplatin)/NP (vinorelbine+cisplatin) by the oncologist according to patients' condition. The fire needle was given once a day for 7 days, and chemotherapy was given for 21 days. The control group was treated with chemotherapy alone for 21 days. Before and after treatment, response evaluation criteria in solid tumors (RECIST) was applied for evaluation, and Karnofsky performance status (KPS) and functional assessment of cancer therapy-lung (FACT-L) were applied for evaluation of quality of life in patients with chemotherapy of NSCLC.

RESULTSThe effective rate was 20.0% (6/30) and the stability rate was 73.3% (22/30) in the observation group, which were insignificantly higher than 16.7% (5/30) and 63.3% (19/30) in the control group, respectively (both>0.05). The KPS after treatment was lower than that before treatment in the control group (<0.05); the KPS after treatment was similar to that before treatment in the observation group (>0.05); the KPS in the observation group after treatment was higher than that in the control group (<0.05). The total score and each item score of FACT-L after treatment were higher than those before treatment in the observation group (all<0.05); the physical score and emotional score of FACT-L after treatment were higher than those before treatment in the control group (both<0.05); the total score, physical score, functional score and subscale score in the observation group were significantly higher than those in the control group after treatment (all<0.05), while the social/family score and emotional score in the observation group were insignificantly higher than those in the control group (both>0.05). The differences of KPS total score before and after treatment in the two groups had moderate positive correlation with differences of FACT-L total score (<0.01).

CONCLUSIONFire needle can improve quality of life in patients of NSCLC chemotherapy.

Objective To investigate high risk human papillomavirus(HR-HPV)prevalence among married women in Beijing and to study the high risk flactors.nethods During March 2007 to September 2008.a total of 6185 married women sampled from 137 communities in 12 districts were screened bv HR-HPV DNA test and cytogical test.The interview was carried out with unified questionnaires.The databage was set up and twice entered in EpiDam 3.0.After checked up,the data were analyzed in SPSS 15.0.Results (1) The HR-HPV infection rate was 9.89%.The HR-HPV infection rate of the city zone,the suburb and the exurb were 9.34%,10.51% and 9.51% (P>0.05).The HR-HPV infection rate of the native and the oudander were 9.53%,11.30% (P<0.05).(2) The age distribution of HR-HPV infection was that the rate was around 10% among 25 to 44 age groups,which was the highest(11.21%) in 30 to 34 age group;then the rate was descended as the age raising,the rate of 50 to 54 age group was the lowest(7.78%).(3) Multiple logistic regression showed that the related risk factors of HR-HPV infection mainly included 1000 RMB and above of family income per person per month.possessing more than 1 sexual partner of her husband,outlander and hish levels of education.(4) The prevalence of cervical intraepithelial neoplasia(CIN)in HR-HPV positive group wag significantly higher than that in HR-HPV negative group(29.76% vs 3.32%,P<0.01).Conclusions(1)The HR-HPV infection rate among aged 25 to 54 years was 9.9% and there was no significant difference in area distribution.(2)The hish risk population which should strengthen screening was the married bearing-age women with high level of family income,outlander,high levels of education and her husband possessing more than 1 sexual partner.(3)HR-HPV infection is the main risk factor for CIN and cervical cancer.while does not provide a causal relationship with them.The high risk population should be checked regularly to understand the development of HR-HPV infection and CIN incidence.