Objective To investigate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy (CRRT) in patients at high risk of bleeding. Methods Forty-seven patients who needed to CRRT and were admitted into the department of critical care medicine from January 2015 to October 2016 were enrolled in this study. According to the patient′s actual condition, they were divided into citrate groups (24 cases) and saline group (23 cases). Patients in saline group were given saline wash. The efficacy and safety were compared between the two groups. The filter lifetime, after treatment the activated partial thromboplastin time (APTT), hemoglobin (Hb), blood gas indexes were compared between the two groups. Results The citrate group used 76 filters while the 0.9% sodium chloride group used 87 filters. The average filter lifetime in citrate group was (22.4 ± 12.7) h which was longer than (8.6±3.3) h in 0.9%sodium chloride group (t=9.79, P<0.01). The incidence of coagulation in extracorporeal circulation was 3.9%(3/76) which was lower than 16.1%(14/87) in 0.9%sodium chloride group(χ2=5.20, P<0.05). Conclusions Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.

Objective To explore the safety and feasibility of single-incision laparoscopic cholecystectomy without using titanium-clips. Methods Data of 1016 patients(group A) undergoing single-incision laparoscopic cholecystectomy without using titanium-clips were compared to that of 874 patients(group B)undergoing two-port laparoscopic cholecystectomy without using titanium-clips by t test and chi square test for operating time,operative hemorrhage,the length of postoperative hospital stay and postoperative pain.Results In group A,1001 cases were successfully operated on with single-incision laparoscopic cholecystectomy,with conversion to classic four-port laparoscopic cholecystectomy in 15 cases,while 874 cases in group B were operated on with two-port laparoscopic cholecystectomy.There were no bile leakage,biliary tract injury or death in both groups.There were no difference in operating time[(34.5 ±5.2) min vs (32.0±7.4)min,t=0.063,P=0.526],the length of postoperative hospital stay[(3.1±0.8)d vs(3.2±0.7)d,t=1.073,P=0.326]and operative hemorrhage[(56.5±17.8)ml vs (55.2±15.9)ml,t=0.812,P=0.425](P>0.05) between the two groups,but the postoperative pain was less severe in Group A than that in group B (P=0.000<0.05). Conclusions The single-incision laparoscopic cholecystectomy is feasible,safe,less traumatic and more cosmetic.

Objective To study the diversities of imaging, symptoms, electrophysiology and clinical value of the stereoelectroencephalography(SEEG) in patients with mesial temporal lobe epilepsy.Methods Eight patients with intractable epilepsy in Epilepsy Center of Yuquan Hospital of Tsinghua University who underwent mesial temporal lobectomy were recruited in this study, and their epileptic foci could not be accurately positioned.Therefore stereotactic brain electrodes were implanted, and their usual attack originated from mesial temporal lobe structure were confirmed.There was no seizure in the one year follow-up.Results Symptoms of the eight patients behaved differently, and the onset of the seizures in scalp electroencephalograph or SEEG showed diversities.Epileptic discharges were found originated from the mesial temporal lobe after implanting electrodes: in the early stage of discharges, four cases had the conduction to insular lobe structure;two cases had the conduction to contralateral mesial temporal lobe;one case had the conduction to retrosplenial cortex;one case had the conduction to parietal lobe;one case had the conduction to frontal lobe and rapid generalization (one case had the conduction to insular lobe and contralateral mesial temporal lobe meanwhile).Conclusions There is difference in clinic, imaging and electrophysiology of the patients with mesial temporal lobe epilepsy The non-specificity can be explained by the evolution of the intracranial electroencephalography, which can help us know its network conduction pattern Insular lobe is the most common conduction approach of mesial temporal lobe epilepsy in early stage SEEG can be used as a microinvasive, accurate preoperative localization method, which can help us to locate accurately and understand the discharges and conduction mode.

Nanobody is a kind of antibody from camel, which misses light chain. Nanobody has the same antigen binding specificity and affinity as mAb. Moreover, because of its small molecular weight, high stability and easy preparation, nanobody has great value of biomedical applications. In this study, we successfully prepared highly pure antiEGFR nanobody in E.coli using genetic engineering techniques. Cell proliferation assay (CCK-8 assay) and migration experiments (cell scratch test and Transwell assay) indicated that the recombinant antiEGFRnano can significantly inhibit the proliferation and migration of endometrial cancer cells. These results provide a new way of thinking and methods for EGFR-targeted therapy of endometrial cancer.

Objective To investigate the protective effect of CBLB 502 on radiation pneumonitis and pulmonary fibrosis for confirming the feasibility of CBLB502 as a clinical anti-radiation drug release.Methods With a single 20 Gy irradia-tion, C57BL/6J mice was sacrificed on 24 h, 1 month, 3 months and 5 months and lung tissue was assayed by TUNEL method for apoptosis of alveolar epithelial cells and endothelial cells , HE staining showing fibrosis changes , immunohisto-chemistry detecting the expression of specific indicators , as well as pathological changes of the fur and skin radiated site . Results CBLB502 inhibits apoptosis in mice alveolar epithelial cells and vascular endothelial cells after irradiation , slowing the process of pulmonary fibrosis , while reducing the expression of laminin and maintaining the expression of surfac-tant protein B, and the skin inflammation also significantly reduced .Conclusion CBLB502 could alleviate the occurrence of radiation pneumonitis and pulmonary fibrosis as well as radiation-induced skin injury .

ObjectiveTo investigate the clinical features of extrahepatic biliary adenoma and the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of extrahepatic biliary adenoma. MethodsA retrospective analysis was performed for the clinical manifestations, imaging findings, ERCP treatment, and follow-up data of 7 patients with extrahepatic biliary adenoma who were admitted to Department of Gastroenterology in The People′s Hospital of Northern Jiangsu from January 2010 to June 2016. Results Selective ERCP was performed for 7 patients after the exclusion of surgical contraindications. Intraoperative cholangiography showed interruption of different parts of the bile duct, and brush cytology under the guidance of guide wire and bile duct biopsy with ultrafine biopsy forceps were performed for all patients. The pathological examination showed bile duct adenoma. Among these patients, 6 were treated with ERCP and 1 was treated with Roux-en-Y choledochojejunostomy after ERCP. ConclusionAs a minimally invasive examination, ERCP helps to determine the cause of the disease and evaluate patients′ condition. When patients have surgical contraindications or are not willing to choose surgery, ERCP can be used as palliative therapy to relieve their clinical symptoms.

Objective To propose a novel stereo-electroencephalography(SEEG) quantitative measure analyzing ictal high frequency (60-90 Hz) and calculating high frequency epileptogenicity index (HFEI) to localize epileptogenic zone and evaluate epileptogenic network. Methods The clinical presurgical evaluation and SEEG data of 15 patients who were performed SEEG electrodes implantation from April 2015 to March 2016 were analyzed retrospectively. Post-implantation head CT images and 3D MRI data were fused for accurately identifying and locating each electrode contact. Ictal SEEG quantitative measure HFEI was calculated and threshold was set. The epileptogenic network was divided into focal, regional, multiple regional and bilateral ones and the results were compared with the pathological results.Results The epileptogenic network was focal for four patients, regional for four patients, multiple regional for six patients and bilateral for one patient (7/15). In terms of the pathology,two cases with hippocampal sclerosis both showed regional network. In four cases with cerebral malacia, two cases showed multiple regional network and the other two cases showed focal network. In six cases with cortical malformation, three cases showed multiple regional network, the other three cases showed focal, regional and bilateral networks respectively. Conclusions We explored a novel SEEG quantitative measure based on the high frequency power analysis,which is objective and could localize epileptogenic zone and evaluate the epileptic network.

Objective To establish and validate the ascites volume forecast model of ascites puncture drainage operation with ultrasound measuring for 6 positions in patients with ovarian hyperstimulation syndrome (OHSS),including front of the uterus,Douglas pouch,right iliac fossa,left iliac fossa,hepatorenal recess and spleen kidney fossa.Methods Fifty patients received ultrasonographic measurement (measurement group) and then underwent ascites puncture drainage operation within 6 h.Three scatter diagrams of actual ascites volume (Y;ml) and key position ascites depth summation (X;mm),height correlation coefficient and surface area correlation coefficient were drawn.The simple and practical regression equation with better correlation was used to be the one verified.Then 100 subsequently HSS patients were enrolled in verrification group.Forecast ascites volume calculated with above-mentioned regression equation and actual ascites volume was analyzed with Bland-Altm an method and paired t test.Results Regression equation obtained with the scatter diagram was Y=-256.554 + 10.452X (R2 =0.577),which could be simplified as Y=10.5X-250.0.The limit of consistency between forecast ascites volume and actual ascites volume was (-1 314.02,1 560.48) ml,and the bias was 123.23 ml.The difference between forecast ascites volume and actual ascites volume was not statistically significant (t=-1.684,P=0.096).Conclusion The simplified equation is Y=10.5X-250.0 to forecast ascites volume caused by OHSS,therefore guiding clinical work.

Objective To determine the association of subclinical hypothyroidism (SCH) with body composition (measured by body impedance analysis) and insulin resistance (IR) in overweight/obese patients with polycystic ovary syndrome (PCOS).Methods A retrospective analysis was conducted of the clinical records of 109 overweight or obese [body mass index (BMI) ≥ 24 kg/m2] PCOS patients who visited the Department of Endocrinology and Fertility Center of Nanjing Drum Tower Hospital between April 2013 and April 2016 for menstrual disorder or infertility and were referred to receive weight management.24 of the patients had SCH,and 85 had euthyroid (EU).We determined the body composition of the patients with Biospace Inbody 720 body composition analyzer,measured the patients' serum lipid profiles,conducted in each patient the 75 g oral glucose tolerance test and the insulin release test,and calculated the homeostasis model assessment of insulin resistance (HO-MA-IR) indices.Results Patients with SCH and autoimmune thyroiditis (AIT) accounted for 22.02％ and 24.36％ of the total.The obesity level [(145.19±13.75)％ vs.(153.31±18.15)％,t=-2.032,P=0.045],VFA [(132.48±20.85) cm2vs.(147.35±24.26) cm2,t=-2.730,P=0.007],body fat (BF) [(31.91±5.88) kgvs.(35.43±6.89) kg,t=-2.274,P=0.025],body fat percentage (BFP) [(40.92±3.701)％ vs.(43.07±4.26)％,t=-2.241,P=0.027],body mass index (BMI) [(30.49±2.88) kg/m2 vs.(32.19±3.81) kg/m2,t=-2.026,P=0.045] and waist circumference (WC) [(98.34±7.13) cm vs.(102.86±8.74) cm,t=-2.324,P=0.022] of SCH group were significantly lower than those of euthyroid,with significant statistical difference.The levels of serum thyroid hormone (TSH) in patients with EU were positively correlated with the degree of obesity,the BF,the BFP,the BMI and the hip circumference (P=0.019,0.042,0.005,0.019,0.039),but not with the VFA (t=1.797,P=0.076).There were no statistically significant differences (P＞ 0.05) between patients with SCH and those with EU in their HOMA-IR indices,insulin levels,blood glucose,blood lipid,and ratio of IR (defined as HOMA-IR ≥2.69).Conclusions Obesity related body composition parameters were lower in PCOS patients with SCH than in those with EU.However,there was no significant difference between the two groups in blood lipid level and the ratio of IR.TSH levels in the EU group were correlated with the BMI and the BFP,but not with the VFA.A larger sample is needed to identify how and why thyroid hormones may affect the body composition and glycolipid metabolism of females with PCOS.

Objective:To analyze the characteristics of stereoelectroencephalography (SEEG) in children with drug-resistant epileptic spasms (ES), and to explore the surgical strategy of children with spastic seizure under the guidance of SEEG.Methods:The clinical data of 156 children with ES who were preoperatively evaluated in the Department of Neurosurgery Ward 3, Tsinghua University Yuquan Hospital from January 2014 to December 2021 were retrospectively reviewed.All children were evaluated in the second stage of stereotactic electrode placement after a non-invasive preoperative evaluation.The characteristics of intracranial EEG, surgical strategy and prognosis were analyzed.Results:A total of 19 eligible children were included, involving 13 boys and 6 girls.The age of first onset and surgical age of them ranged 1 month to 4 years, and 2 years to 13 years, respectively.The SEEG was divided into 3 types in children with ES at the onset.Five children were SEEG type A, presenting with the focal seizure discharges at the beginning and a gradual propagation to widespread fast-wave bursts.Ten children were SEEG type B, presenting a focal leading spike followed by diffused fast-wave bursts.Four children were SEEG type C, presenting a diffuse fast wave rhythm onset.Although some electrode discharges appeared slightly " leading", they covered more than one brain region.After focal resection or thermocoagulation, 13/19 patients did not have the onset of seizures, and 5/19 and 8/19 were graded as SEEG type A, and B, respectively.During the intermittent period of SEEG attacks in children with SEEG type A and B, a significant phenomenon of focal epileptic discharge consistent with the onset of the attack was observed, and surgical removal of these areas effectively controlled spastic seizures.Conclusions:Epileptic spasms may be triggered by a focal neocortical discharge.Intracranial EEG showed that the focal seizure onset evolves into spasm or a focal " leading spike" is a good indicator of surgical prognosis.