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 construct a safe,stable and credible system for the running of network system and improve its application effect.Method Starting with the information system construction in Xijing hospital,the existent network system was programmed and rebuilt by establishing a assistant switch core and constructing multi-center redundancy link.Conclusion The rebuilt information system of Xijing hospital attains the anticipated effect,and shows rationality and practicability in use.What's more,combined with actual experience,the rebuild of hospital network system was summarized and suggestions were given.

Objective To study the expression of toll rexeptor-4 in patients with systemic infanunatory response syndrome(SIRS)and multiple organ dysfunction syndrome (MODS) induced by acute cerebral vascular disease(ACVD).Method Totally 153 ACVD patients,admitted to Departments of Neurology Medicine and ICU of the First,the Second and the Forth Hospitals of Jilin University from October 2005 to March 2006,were enrolled in this study.The patients were admitted to the hospitals within 3 days after onset,and were confirmed by CT or MRI.The 153 patients in the prospective study was divided into three groupa:ACVD group(n=60).SIRS group induced by ACVD(n=45),MODS group induced by ACVD(n=48).The diagnosis criteria accorded with the criterion set by the Forth Conference of Cerebrovuscular Disease in China.The exclusion criterion inchided:①patients with infeetion or inflammatory disease two weeks before the onset of AVCD;②patients with cardiac disease,including acute myocarditis,acute myocardial infarction,angina episodes,degenerative calcific valvular disease,and so on;③patients with use of hormone recently;④malignant tumor,autoimmunity system disease,liver disease,kidney disease and hematologic disease.The expression of TLR-4 mRNA gene of the nucleated cell in the peripheral blood in the ACVD patient was measured by using RT-PCR.Statistics methods of t test,q test and simplex factor analysis of variance have been used Statistical analysis was carried out by using T-test,one-way analysis of variances,and q-test.Results The expression of TLR-4mRNA obviously increased on the third day after onset of AVCD.Compared with ACVD group,the expression of TLR-4mRNA in SIRS group was significantly higher (0.61±0.13 vs.0.98±0.15,P＜0.01).Compared with SIRS group,the expression of TLR-4mRNA in MODS group was significantly higher(0.98±0.15 vs.1.32±0.38,P＜0.01).The expression of TLR-4mRNA had a increasing tendency with the severity of AVCD.The expression of TLR-4mRNA was higher in patients with higher MODS score(P＜0.01).In the MODS group,the expression of TLR-4 mRNA was higher in the fatal patients than that in the survivors(1.56±0.16 vs.1.32±0.26,P＜0.01).Conclusions The mechanism of ACVD.which causes SIRS and MODS,may be associated with excessive immunologic respun of the organism.

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 To study the relationship between expression of matrix metalloproteinases-7 (MMP-7) and clinicopathological characteristics in patients with primary non-smaU cell lung cancer(NSCLC). Methods MMP-7 in 20 normal people and 60 advanced NSCLC patiens were detected with reverse-transcription-polymerase-chain-reaction. Gelatum image analysator analyzed the result. Results The amount of MMP-7 was less in normal people (30.000) than in NSCLC patients(41.231) significantly(P<0.05); the level of MMP-7 was no correlated with gender, age, pathology pattern, tumor size, was inverse correlation with differentiation, and was positive correlation with clinical stages(P <0.05). Conclusion The level of MMP-7 is closely correlated with tissue differentiation and clinical stages of NSCLC, which may serve as a parameter for determining tumor invasion and metastatic.

Objective To discuss the expression and significance of neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte ratio(PLR) in peripheral blood in patients with chronic obstructive pulmonary disease(COPD).Methods One hundred and fifty cases COPD patients who were treated in Respiratory Departments of Hai'an People′s Hospital Affiliated to Nantong University from January to December 2015 were selected and divided into stable period group with 60 cases and acute exacerbation period group with 90 cases,and 50 healthy subjects were selected as control group.Clinical data were collected and white blood cell count(WBC),neutrophil count(NC),lymphocyte count(LC),platelet(PLT),NLR,PLR,forced expiratory volume in one second(FEV1%) predicted and C reactive protein(CRP) were tested.Results NLR,PLR and CRP values were significantly higher in patients in acute exacerbation period group than in stable period group and control group(NLR:(10.30±9.93) vs.(6.76±5.90) vs.(5.85±3.67);PLR:(335.88±164.94) vs.(286.80±118.98) vs.(194.11±88.14);CRP: (42.18±24.89) mg/L vs.(23.27±13.59) mg/L vs.(22.49±13.47) mg/L,F=6.637,6.808,11.007,P<0.05),but FEV1% predicted was no difference in stable period group and acute exacerbation period group((58.85±16.83)% vs.(57.47±17.76)%;t=0.228,P>0.05).There was a significant positive correlation between NLR,PLR and CRP in acute exacerbation period group(r=0.374,0.379,P<0.01),there was a positive correlation between NLR and PLR(r=0.482,P<0.01),there was a negative correlation between NLR,PLR and FEV1(r=-0.297,-0.299,P<0.05).There was a significant positive correlation between NLR,PLR and CRP in table period group(r=0.593,0.433,P<0.01),NLR and PLR were also positively correlated(r=0.618,P<0.01),NLR,PLR and FEV1 accounted for the expected value of the negative correlation(r=-0.324,-0.342,P<0.05).Conclusion Both NLR and PLR are inflammatory markers,furthermore they show a significant negative correlation to airflow limitation in patients with COPD.

Lung cancer is the most common malignant tumor worldwide. There are more than 700000 new cases diagnosed as lung cancer each year in China, of which 80％-85％ are non-small cell lung cancer (NSCLC). The mutation proportion of epidermal growth factor receptor (EGFR) may reach up to 40％-55％. EGFR-tyrosine kinase inhibitor (EGFR-TKI) has become the standard first-line treatment method for advanced NSCLC patients with EGFR mutation. Chinese oncologists have done a large number of clinical studies, providing an important evidence-based medicine proof for treatment of advanced NSCLC with EGFR mutation.

Objective To explore the effect of airway humidification on lung injury as a result of mechanical ventilation with different tidal volume(VT). Methods Twenty-four male Japanese white rabbits were randomly divided into four groups:low VT with airway humidification group,high VT with airway humidification group,low VT and high VT group without humidification,with 6 rabbits in each group. Mechanical ventilation was started after intubation and lasted for 6 hours. Low VT denoted 8 mL/kg,while high VT was 16 mL/kg,fraction of inspired oxygen (FiO2)denoted 0.40,positive end-expiratory pressure(PEEP)was 0. Temperature at Y piece of circuit in airway humidification groups was monitored and controlled at 40℃. Arterial blood gas analysis,including pH value,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),lung mechanics indexes, including peak airway pressure(Ppeak)and airway resistance(Raw),and lung compliance was measured at 0,2,4, 6 hours of mechanical ventilation. The levels of tumor necrosis factor-α(TNF-α)and interleukin-8(IL-8)in plasma and bronchoalveolar lavage fluid(BALF)were determined by enzyme linked immunosorbent assay(ELISA). The animals were sacrificed at the end of mechanical ventilation. The wet to dry(W/D)ratio of lung tissues was calculated. Histopathologic changes in the lung tissueies were observed with microscope,and lung injury score was calculated. Scanning and transmission electron microscopies were used to examine the integrity of the airway cilia and the tracheal epithelium. Results Compared with low VT group,pH value in high VT group was significantly increased,PaCO2 was significantly lowered,and no difference in PaO2 was found. Ppeak,Raw,and lung compliance were significantly increased during mechanical ventilation. There were no significant differences in blood gas analysis and lung mechanics indexes between low VT with airway humidification group and low VT group. Compared with high VT group,PaCO2 in high VT with airway humidification group was significantly decreased,Ppeak raised obviously,and no difference in pH value,PaO2,Raw and pulmonary compliance was found. Compared with low VT with airway humidification group,no difference in blood gas analysis(PaCO2,mmHg,1 mmHg=0.133 kPa)was found,but Ppeak(cmH2O,1 cmH2O=0.098 kPa),Raw(cmH2O),and lung compliance(mL/cmH2O)were increased significantly in high VT with airway humidification group(PaCO2 at 2 hours:27.96±4.64 vs. 36.08±2.11,4 hours:28.62±2.93 vs. 34.55±5.50, 6 hours:29.33±2.14 vs. 35.01±5.53;Ppeak at 0 hour:14.34±1.97 vs. 8.84±1.32,2 hours:17.33±0.52 vs. 11.17±2.14,4 hours:17.83±0.98 vs. 12.67±2.06,6 hours:18.67±1.22 vs. 13.50±2.16;Raw at 0 hour:37.36±5.14 vs. 27.05±2.93,2 hours:43.94±6.58 vs. 31.95±3.56,4 hours:48.04±6.07 vs. 35.24±3.50, 6 hours:50.33±6.34 vs. 36.66±3.64;pulmonary compliance at 6 hours:2.28±0.18 vs. 1.86±0.37,all P<0.05). The lung W/D ratio in high VT group was significantly higher than that of the low VT group(6.17±2.14 vs. 3.50±1.52, P<0.05). W/D in high VT with airway humidification group was higher than that of low VT with airway humidification group but without statistically significant difference(5.17±2.14 vs. 3.00±1.10,P>0.05). Microscopic observation showed that cilia were partially detached,adhered and sparse in low VT group,while cilia in high VT group showed serious detachment and lodging. Remaining cilia were sparse,with lodging,and cellular structure was damaged. Lung tissue pathological injury score in the high VT group was significantly higher than that of low VT group(6.17±2.14 vs. 3.50±1.52,P<0.05). Cilia density and cellularity were normal in low VT with airway humidification group,and no difference in lung tissue pathological injury score was found compared with low VT group(3.00±1.10 vs. 3.50±1.52, P>0.05). Cilia were severely detached,adhered and lodging,and cellularity were not obvious in high VT with airway humidification group,and lung tissue pathological injury score was elevated significantly than that of the low VT with airway humidification group but without statistically significant difference(5.17±2.14 vs. 3.00±1.10,P>0.05). TNF-α and IL-8 concentrations showed no change in plasma and BALF in all groups during ventilation,and no significant difference was found among the groups. Conclusions Airway humidification can alleviate pathological lung injury,damage of cilia and cellular structure in trachea caused by mechanical ventilation with low and high VT. High VT with humidification can result in serious pulmonary edema.

Objective:To evaluate the application value of electrical impedance tomography(EIT)imaging combining bedside bronchoscopy sputum suction by observing the changes of pulmonary ventilation, tidal volume and dynamic pulmonary compliance after bedside bronchoscopy sputum suction in elderly stroke-associated pneumonia(SAP).Methods:A randomized controlled study was conducted.Patients with SAP admitted to the respiratory intensive care unit of Henan Provincial People's Hospital from January 2017 to December 2018 were enrolled as research objects.They were divided into the control group versus observation group with the only difference in receiving bedside bronchoscope sputum suction replacing control's receiving conventional sputum suction.Impedance imaging region of interest 4(ROI4)values collected by using EIT at admission and 1, 3, 5 days after fiberoptic bronchoscope sputum suction were compared between the two groups.Meanwhile, the tidal volume, dynamic lung compliance, the duration of mechanical ventilation and hospitalization time in intensive care unit were recorded in the two groups.Results:A total of 78 patients meeting an inclusion and exclusion criterion were enrolled, with 37 cases in the control group and 41 cases in the observation group.Compared with control group, the bronchoscope sputum suction group showed the significantly increased regional gas distribution values(2.24±0.77% vs.0.49±0.65%, 7.05±0.77% vs.2.49±0.87%, 12.34±1.47% vs.5.57±0.50%, t=10.85, 24.56 and 26.54, respectively, all P<0.001)at 1, 3, 5 days after fiberoptic bronchoscope sputum suction.The tidal volume and dynamic lung compliance were significantly higher in the observation group than in the control group at 1, 3, 5 days after fiberoptic bronchoscope sputum suction.The duration of mechanical ventilation and hospitalization time in the intensive care unit were shorter in the observation group than in the control group(12.22±0.88 d vs.14.65±0.92 d, 18.41±1.12 d vs.21.14±1.06 d, t=11.91 and 11.01, both P< 0.001). Conclusions:For patients with SAP, an intermittent bedside fiberoptic bronchoscope sputum suction can effectively improve the pulmonary ventilation in the dorsal area, optimize pulmonary respiratory dynamics, facilitate the early withdrawal of the mechanic ventilation, and shorten the hospitalization time in the intensive care unit.

Objective To explore the prognosis and management of atrial fibrillation (AF) in patients with atrial septal defect(ASD) accompanied by AF after transcatheter closure of ASD. Methods During the period from July 2010 to May 2013, a total of 24 patients with ASD accompanied by AF were admitted to authors’ hospital to receive transcatheter closure of ASD. Electrocardiogram (ECG), chest X-ray film and transthoracic echocardiography (TTE) were performed before and one day after the operation. Follow-up information was obtained through telephone or at out-patient clinic interview. Results Successful occlusion of ASD was obtained in all patients, and in no patient the AF rhythm turned to sinus rhythm after the procedure. In one patient preoperative AF turned to postoperative atrial flutter, and AF recurred in one case who had received transcatheter ablation of AF before the procedure. One female patient developed gastric bleeding during the course of orally taking warfarin, and she died of cerebral infarction at three days after ceasing the use of warfarin. Of the 24 patients, no anticoagulant drug was used in 5 (20.8%), oral administration of aspirin was given in 7 (29.2%), and oral medication of warfarin was employed only in 11 (45.8%). Conclusion The spontaneous conversion rate of AF is very low in patients with ASD complicated by AF after transcatheter closure of ASD. Postoperative medication of anticoagulation should be strictly standardized and carefully managed.