Objective To evaluate the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) combined with endoscopic retrograde cholangio-pancreatography (ERCP) in treating malignant obstructive jaundice, and to discuss its technical points. Methods A total of ten cases with malignant biliary obstruction were enrolled in this study. After the failure of ERCP treatment, the patients had to be treated with ultrasound-guided PTCD immediately. The guide-wire was inserted into the duodenum through intrahepatic bile duct and common bile duct to connect with ERCP, which was followed by the biliary stent implantation or the removal of physical factors causing obstruction. The clinical results were analyzed. Results Technical success was obtained in all 10 cases. In the patients who underwent a successful guide-wire docking with ERCP the postoperative serum bilirubin was significantly decreased. The main complications were fever, elevation of amylase and transient bloody bile. Conclusion With the help of docking technique the combination use of ultrasound-guided PTCD and ERCP is a new tentative treatment for malignant obstructive jaundice after the failure of initial ERCP treatment. This technique carries promising value in clinical practice as it can significantly increase the success rate of ERCP.

Objective This retrospective study was to explore the efficacy and determine the risk factors of survival for recurrent hepatocellular carcinoma ( HCC) treated by repeat hepatectomy. Methods From January 1995 till December 2010, 60 patients with recurrent HCCs, were treated by repeat hepatectomy.The significance of seventeen clinical or pathological variables in the risk factors of overall survival were assessed. Results The overall survival 1,3, and 5-year survival rates were 76. 3% , 40.7% and 25. 0% (from repeat hepatectomy), and 95. 0% , 62. 6% and 43. 3% ( from initial hepatectomy) , respectively.Univariate analysis indicated that tumor size at initial hepatectomy, recurrence interval from initial hepatectomy, serum albumin(ALB) level, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P <0. 05, Kaplan-Meier Log-rank test). Multivariate analysis showed recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P<0.05, Cox proportional hazards model).Conclusion Repeat hepatectomy is effective for recurrent HCC. Recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors.

Objective To elevate the achievement rate of kidney biopsy puncture through the analysis of puncture angle choice of ultrasound guided automatic kidney biopsy in 518 patients. Methods Under the guidance of color Doppler ultrasound,using the 3.5MHz probe with probe holder,we performed kidney biopsy in the degrees of 40°(group X),45°(group Y),60°(group Z) and 70°(group P) with the horizontal plane. Resnlts The total achievement ratio is 100 %. The one time success rate in group Y and group Z is 100 % (group Y, 164/164 ; group Z, 186/186) ;group X is 4.8% (22/46) ;group P is 84.4% (103/122).Conclusion The automatic kidney biopsy an- gle under the guidance of ultrasound should be between 45° and 60° with the horizontal plane which is safe and has higher achievement ratio. In the meantime, complications can be avoided.

Objective: To analyze the epidemiological characteristics of varicella epidemic situation at schools and kindergartens in Fengxian district of Shanghai during 2012-2018, and to provide evidence for developing control and prevention strategies. Methods: Data of varicella epidemic situation at schools and kindergartens and varicella cases were analyzed by descriptive methods. The rates were compared with chi-square test. Results: A total of 6 727 varicella cases were reported in Fengxian during 2012-2018, for an incidence of 85.34 per 100 000 population. Totally 66 varicella epidemic outbreaks and public health emergencies caused by varicella were reported, which involved 741 varicella cases. Among them, 426 were breakthrough cases (57.49%). The average interval time of breakthrough cases were (6.78±2.79)years, and the incidence was more concentrated in the 3-9 years after vaccination with varicella vaccine. Most breakthrough cases appeared 5 years past vaccination. The peak time of varicella was from April to June and from October to December. Most of cases were in the 5-11 year-old group and 15-17 year-old group. The cases in males was higher than in females. Kindergarten childcare and primary school children were at high risk of varicella. Timeliness of reporting was positively correlated with the duration of the varicella epidemic situation( r =0.52， P <0.05). Conclusion Most varicella epidemic situation in Fengxian district of Shanghai occued in primary schools during autumn and winter, and most of the varicella cases were breakthrough cases. Emergency vaccination of varicella vaccine can effectively control the spread of the epidemic. It is suggested to increase the publicity of the immunization program of 2 doses of varicella vaccine and raise the awareness of varicella vaccination of children’s parents.

Objective To investigate the efficacy and safety of endoscopic radiofrequency ablation on patients with advanced stage unresectable cholangiocarcinoma. Methods Clinical data of 45 cases with unresectable cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography from October 2011 to October 2014 were collected. The patients were divided into two groups: the group A included 23 cases undergoing radiofrequency ablation, and the group B included 22 cases without ablation. The occurrence of complications, the postoperative levels of CA19-9 and total bilirubin ( TBIL) in blood plasma, the patency of stents, and survival period were compared between the two groups. Results All of the 45 patients completed treatment, and no perforation, bleeding and bile leakage occurred. In the group A, 2 patients got fever and 5 patients got pancreatitis after operation, and the number in the group B was 3 and 4, respectively. Their symptoms disappeared after suitable treatment. The postoperative pain rate in group A ( 21. 7％, 5/23) was significantly lower than that of group B ( 54. 5％, 12/22,χ2=5. 148, P=0. 023) . At 7th day of post-operation, the levels of CA19-9 in the two groups were 960. 5 ± 362. 7 U/mL and 979. 3 ± 378. 1 U/mL, respectively, and the levels of TBIL were 95. 25±28. 36μmol/L and 98. 75±20. 76μmol/L, respectively, which were not significantly different between the two groups( P>0. 05) , but were significantly decreased compared with the levels of pre-operation ( P<0. 05) . The patency of self-expandable metal stent in group A ( 60. 0％, 6/10) was significantly higher than that of group B ( 10. 0％, 1/10,χ2=5. 495, P=0. 019) 9 months after operation. Kaplan-Meier analysis showed that the median survival time in the two groups had no statistical difference [ 271. 0 days ( 95％CI: 168. 4-373. 4days ) VS 245. 0 days ( 95％CI:200. 3-289. 7 days), χ2=1. 380, P=0. 258]. Conclusion For the patients with advanced unresectable cholangiocarcinoma, endoscopic radiofrequency ablation is able to relieve cancer pain, prolong the patency of stents, and improve the life quality, which deserves clinical applications.

Objective Using dynamic glucose monitoring system to investigate the influence of dynamic glucose excursion onthe serum cystatin C (Cys-C) in patients with type 2 diabetes mellitus (T2DM).Methods A total of 164 hospitalized patients with T2DM were selected in this study.All the patients underwent continuous 72 hours dynamic glucose monitoring.The parameters of glucose excursion were calculated,including blood glucose standard deviation (SD),and average blood glucose level (MBG).According to the monitoring results,the patients were divided into two groups:high blood glucose excursion groupand low blood glucose excursion group.Cys-C level and other biochemical parameters were detected.Then the correlation of SD and Cys-C was analyzedin the two groups.Results There were significant difference in age,urea nitrogen (BUN),serum uric acid (SUA),glomerular filtration rate (eGFR),and Cys-C levels between the two groups (P＜ 0.05).The mean value of Cys-C and the percentage of high Cys-C level were higher in high blood glucose excursion group than in low blood glucose excursion group.There was a positive correlation between SD and Cys-C (r=0.344,P＜0.01) in the whole group as well as in high blood glucose excursion group and low blood glucose excursion group (r=0.604,0.331,P＜0.01).The incidence of diabetic peripheral arterial disease(PAD),diabetic peripheral neuropathy(DPN),diabetic retinopathy(DR),DKD were higher in high blood glucose excursion groupthan in the low blood glucose excursion group.Multivariate stepwise regression analysis showed that WC,GA,FPG,FIns,SUA,eGFR,and SD were in dependent risk factors for Cys-C,and among them,SD had the greatest contribution(β=0.112,SE=O.025,P=0.000).Conclusion The dynamic glucose excursion is positively correlated with Cys-C in patients with T2DM.The greater the blood glucose excursion,the higher the Cys-C level.

Objective To explore the effects of bundle care on preventing deep vein thrombosis (DVT) in elderly patients with gastrointestinal carcinoma in the perioperative period. Methods The elderly patients who received surgery for gastrointestinal carcinoma in the Department of Oncological Surgery of the Affiliated Hospital of Jiangnan University were selected as subjects in this study according to quasi-experimentation. Totally 220 patients admitted between January and December 2016 were divided into an observation group, who received bundle care as planned, while another 216 patients admitted from January to December 2015 were divided into a control group, who received conventional nursing for patients with gastrointestinal carcinoma in the perioperative period. The incidence of DVT, duration of hospital stays and satisfaction were then compared between the patients in the two groups. Results Totally 13 patients in the control group, while only 4 in the observation group, showed DVT (χ2=5.132,P<0.05). The average duration of hospital stays of the patients in the observation group was (17.27±6.17) days, shorter than that of the patients in the control group (t=34.924, P<0.01). The patients in the observation group scored (9.75±0.24) in satisfaction with nursing, higher than that of the patients in the control group (t=11.155,P<0.01). Conclusions Bundle care can help to reduce the incidence of DVT in elderly patients with gastrointestinal carcinoma in the perioperative period, shorten their average duration of hospital stays, and improve their satisfaction.

Objective To observe the clinical efficacy of closed-loop rehabilitation therapy by brain-computer interface(BCI)combined with exoskeleton robotic hand in patients with hand dysfunction after cerebral infarction and analyze the influence of patients'cognitive function and implicit motor imagery ability on the recognition rate of BCI.Methods A total of 50 patients with cerebral infarction were randomly assigned to the observation group and the control group,25 patients in each group.Both groups received routine rehabilitation programs.In addition to the conventional rehabilitation treatment,the observation group received the closed-loop BCI rehabilitation trainingby brain-computer interface(BCI)combined with exoskeleton robotic hand.The scores of Fugl-Meyer Assessment of the Upper Extremity(FMA-UE),Action Research Arm Test(ARAT),Wolf Motor Function Test(WMFT),and Modified Ashworth scale(MAS)of the wrist flexors were compared between the two groups before and after treatment.Before intervention,the mental rotation test and Montreal Cognitive Assessment(MoCA)were used to assess the baseline implicit motor imagery ability and cognitive level of patients in the observation group.The correlation analysis between these scores and the recognition rate of BCI was conducted to analyze the relevant factors affecting the closed-loop rehabilitation effects of BCI.Results The two groups showed no significant difference in all outcomes before treatment(both P>0.05).After intervention,the observation group exhibited the significantly higher scores of FMA-UE,ARAT,and WMFT(all P<0.05),and significantly lower MAS scores of wrist and finger flexors compared with the control group(all P<0.05).In addition,the recognition rate of BCI was positively correlated with the accuracy of mental rotation test and MoCA score(P<0.05),and negatively corre-lated with the reaction time of mental rotation test(P<0.05).Conclusions Closed-loop rehabilitation training with BCI combined with exoskeleton robot hand can promote the recovery of upper limbs and hand motor function in patients with cerebral infarction.Additionally,the implicit motor imagery ability and cognitive function of patients are suggested to be used for screening the patients suitable for BCI training before the implementation of BCI treatment.

Objective To develop and explore the clinical application effect of orthopedic protective trestle for post-operative patients with lower limb fracture.Methods Totally 60 patients with lower limb fracture that hospitalized in Osteopathic Department from March to June 2015 were randomly divided into the observation group(n=30) and the control group(n=30). Patients in the control group were given Thomas trestle for the fixation while patients in the observation group were given orthopedic protective trestle for the fixation. The pain score, average hospitalization days and patients′satisfaction degree in two groups were compared. Results The pain score of patients in the observation group after 48 h was (3.50±0.63) points, which was significantly lower than the score in the control group (5.53±0.82) points (t=10.78,P<0.05);the average hospitalization days in the observation group was (16.47±2.68) d, which was significantly lower than that in the control group (22.47± 7.32) d (t=4.22,P<0.05);the satisfaction score of patients in the observation group was (8.80±0.61) points, which was significantly higher than the score in the control group (6.93±1.36) points (t=-6.85,P<0.05). Conclusions Orthopedic protective trestle for patients with lower limb fracture can relieve the pain of patients, reduce the length of average hospitalization days and improve the satisfaction of patients.

Objective: To analyze the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus(2019-nCoV) infection in children from six provinces (autonomous region) in northern China. Methods: A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted. The patients were diagnosed between January 25th, 2020 and February 21st, 2020 in 21 hospitals in 17 cities of six provinces(autonomous region) of Shaanxi, Gansu, Ningxia, Hebei, Henan and Shandong. Results: The age of the 31 children with 2019-nCoV infection was 7 years and 1 month (6 months -17 years). Nine cases (29%) were imported cases. Other 21 cases (68%) had contact with confirmed infected adults. One case (3%) had contact with asymptomatic returnees from Wuhan. Among the 31 children, 28 patients (90%) were family cluster cases. The clinical types were asymptomatic type in 4 cases (13%), mild type in 13 cases (42%), and common type in 14 cases (45%). No severe or critical type existed. The most common symptom was fever (n=20, 65%), including 1 case of high fever, 9 cases of moderate fever, 10 cases of low fever. Fever lasted from 1 day to 9 days. The fever of fifteen cases lasted for ≤3 d, while in other 5 cases lasted > 3 d. Other symptoms included cough (n=14, 45%), fatigue (n=3, 10%) and diarrhea (n=3, 9%). Pharyngalgia, runny nose, dizziness, headache and vomiting were rare. In the early stage, the total leukocytes count in peripheral blood decreased in 2 cases (6%), the lymphocytes count decreased in 2 cases (6%), and the platelet count increased in 2 cases (6%).Elevation of C-reactive protein (10%, 3/30), erythrocyte sedimentation rate(19%,4/21), procalcitonin(4%,1/28), liver enzyme(22%, 6/27) and muscle enzyme (15%, 4/27) occurred in different proportions. Renal function and blood glucose were normal. There were abnormal chest CT changes in 14 cases, including 9 cases with patchy ground glass opacities and nodules, mostly located in the lower lobe of both lungs near the pleural area. After receiving supportive treatment, the viral nucleic acid turned negative in 25 cases within 7-23 days. Among them, 24 children (77%) recovered and were discharged from hospital. No death occurred. Conclusions In this case series, 2019-nCoV infections in children from six provinces (autonomous region) in northern China are mainly caused by close family contact. Clinical types are asymptomatic, mild and common types. Clinical manifestations and laboratory examination results are nonspecific. Close contact history of epidemiology, nucleic acid detection and chest imaging are important bases for diagnosis. After general treatment, the short-term prognosis is good.