Objective To evaluate the safety and effectiveness of laparoscopic colectomy in high-risk patients with colonic cancer.Methods A retrospective analysis was conducted to compare the laparoscopic colectomy with open management in high-risk patients with colonic cancer.Statistical analysis were conducted among the indicated surgery-related terms.Results A total of 172 cases were included (65 cases in laparoscopic group and 107 cases in open surgery group).There were no statistically significant difference between two groups in terms of age,gender,body mass index and surgical methods (P ＞ 0.05).But operation time in laparoscopic group,intraoperative blood loss,postoperative fasting time,and drainage tube indwelling time were better than those in open surgery group [(128.5 ± 43.9) min vs.(176.2 ± 39.8) min,t =-7.98,P＜0.01;(120.5 ±38.4) ml vs.(223.0±43.1) ml,t =-16.79,P＜0.01;(2.6±2.1) d vs.(3.2 ± 1.5) d,t =-2.44,P＜0.05; (4.6 ± 3.1) d vs.(7.9 ±3.8) d,t =-6.25,P＜0.01].Conclusion Laparoscopic is colectomy is a feasible and safe management in high-risk patients with colonic cancer.

OBJECTIVE To explore the risk factors in elderly patients with ventilator-associated pneumonia(VAP) and to provide the corresponding clinical prevention strategies.METHODS The ages,underlying diseases,mechanical ventilation method,use of antibiotics,and pathogenic bacteria of the VAP patients were investigated and analyzed.RESULTS Totally 105 elderly patients with VAP had serious underlying diseases,and were treated with broad-spectrum antibiotics,tracheal intubation or trachea incision.Most pathogenic bacteria were multiresistant.CONCLUSIONS Prevention of VAP is the priority of treatment for elderly patients.In order to control the occurrence and spread of VAP,clinicians should shorten the time of ventilator treatment,pay more attention to sterilization and isolation,and strengthen the attendance of the patients.

Abstract: Objective　To explore the accurate diagnosis of children with suspected rare inherited metabolic diseases, and to compare the application value of mass spectrometry and genetic testing in the diagnosis of rare inherited metabolic diseases (IMD). Methods　The clinical information, mass spectrometry, and genetic results of children with suspected rare inherited metabolic diseases admitted to the Department of Pediatrics, the Affiliated Haikou Hospital of Xiangya Medical College, Central South University from March 2017 to December 2021 were analyzed retrospectively. Results　156 children with suspected rare inherited metabolic diseases were detected by mass spectrometry, 67 cases were positive and 89 cases were negative. Children with positive initial examination were retested, and 19 cases were positive. Among the retest positive cases, 13 cases were given genetic testing, and 9 cases were positive and 4 cases were negative. Among the initial negative cases, 54 children with poor therapeutic effect and high clinical suspicion of inherited metabolic diseases completed genetic testing, 15 cases were positive and 39 cases were negative. The results of the two detection methods were compared, the positive rate of mass spectrometry was 19.4%(13/67), and the positive rate of genetic testing was 35.8%(24/67). The continuity correction of Pearson's chi-square test of continuity correction suggested that the results of genetic testing and mass spectrometry were different, and the difference was statistically significant (P<0.05). Taking genetic testing as the gold standard, the sensitivity and specificity of mass spectrometry detection were 37.5% (95%CI:19.6%-59.2%) and 90.7% (95%CI:76.9%-97.0%), respectively. Among the 24 confirmed cases, 5 cases were diagnosed by gene panel and 19 cases were diagnosed by whole exome sequencing (WES). One case diagnosed by WES had no pathogenic mutation detected by gene panel before diagnosis. The detection of DNM1L gene c.1040C>G and AMN gene c.651+1G>C are novel pathogenic gene variants, which have clinical significance. Conclusions　The ability of mass spectrometry in the diagnosis of inherited metabolic diseases is limited. Genetic testing, especially whole exome sequencing, can be the first choice for individualized diagnosis of suspected rare inherited metabolic diseases. In addition, the new mutation sites found by WES in this study enriched the pathogenic gene mutation spectrum and provided direction for further functional biological experiments.

Abstract: Objective To investigate the clinical phenotype and genotype characteristics of mitochondrial encephalomyopathy (ME) families in children. Methods　The clinical data and genetic test results of eleven ME families who were admitted to the department of pediatrics of three tertiary hospitals in Hainan Province from January 2007 to December 2021 were retrospectively analyzed. Results　A total of 13 cases were diagnosed in eleven ME families, including 6 males (46.15%) and 7 females (53.85%). The age of onset ranged from 6 months to 12 years, the interval from onset to diagnosis was 9 months to 8 years and Morava score was 6-11. Clinical symptoms mainly included abnormal movement, developmental retardation or regression, seizures, stroke-like episodes; among the 13 children, 11 (84.62%) had elevated blood lactic acid and 4 (30.77%) had elevated blood creatine kinase. Cranial MRI mainly involved temporal parietal occipital lobe, cerebellum, brainstem and basal ganglia, some with brain atrophy. Gene detection showed that 8 families (72.72%) were caused by mtDNA mutation, of which 5 families and 6 patients were caused by MT-TL1, m.3243A>G, and 5 asymptomatic carriers of 4 families (80.00%) were detected; MT-ND5, m.13513 G>A was detected in 2 families and 3 patients, and an asymptomatic mutation carrier was detected in a family (50.00%); MT-ND3, m.10191T>C was detected in one family and one patient, and 2 asymptomatic mutation carriers were detected. Three families were caused by nDNA mutations (27.27%). A compound heterozygous mutation of c.751C>T and c.516-2A >G in SURF1 gene was found in one family and one patient, which followed autosomal recessive inheritance. The pathogenic loci were inherited from mother and father, respectively. Two new spontaneous mutations c.1040C>G and c.2060_2062delTAG in DNM1L gene were respectively detected in two families and two patients. All children were given mitochondrial cocktail therapy and symptomatic treatment after diagnosis by genetic testing. Follow-up to June 2022, two families were lost to follow-up and 9 families were followed up regularly; three of the 11 children were still survived. Conclusions　For children diagnosed with ME, genetic testing of family members can screen out early asymptomatic pathogenic mutation carriers, achieve early diagnosis of ME and guide clinical genetic counseling. Two new pathogenic sites of DNM1L gene were found in this study, which expanded the genotype spectrum.

Abstract： Objective　To investigate the clinical characteristics and pathogenic genetic mutation of a case with encephalopathy due to defective mitochondrial and peroxisomal fission-1 (EMPF1). Methods　The clinical data and genetic test results of a patient with EMPF1 admitted to the Department of Pediatrics, the Affiliated Hospital of Xiangya Medical College of Central South University in August 2020 were retrospectively analyzed. Results　An 8-year-old girl, her main clinical features were developmental regression, microcephaly, hypotonia, refractory epilepsy, cranial MRI suggesting brain atrophy and abnormal signals in the right temporal-occipital-parietal cortex, aEEG showing slow wave discharge in the right hemisphere; Whole-exome sequencing of families suggested that the child had a heterozygous missense variant at the c.1040C>G site in the DNM1L gene and the verification results by Sanger sequencing showed that her parents had no variant in this site, which was a novel mutation in accordance with autosomal dominant inheritance; bioinformatics analysis predicted that the mutation was pathogenic. After 2 years of outpatient follow-up, the patient's condition was stable after mitochondrial cocktail therapy and antiepileptic drugs, no epileptic seizure occurred in the past year, mental state and swallowing function improved, and she could be fed orally with occasional nausea and vomiting. Conclusions　The main clinical manifestations of EMPF1 are psychomotor developmental delay or regression, dystonia, limb paralysis, epilepsy and so on. According to the clinical phenotype and genetic test results, the rare disease can be diagnosed early.

Laboratory animal science is a preceding subject,which contains particular theory system and characteristics.In order to meet the developmental need of higher medical education and train more medical talents with high quality,the traditional teaching model must be reformed.A series of teaching reforms have been performed and analyzed in this paper.

Through tracing literatures of TCM theories,this article discussed the theoretical basis for treating chloasma from liver.60 female chloasma patients were selected and treated with traditional Chinese medicine of dispersing the depressed liver qi.By observing the score of SDS and SAS,we analyzed the influence of emotion on female chloasma,and the effectiveness of treating chloasma from liver.The article believed that paying attention to regulate the whole body condition will exert a treating at fundamental causeof the disease.

BACKGROUND: Autism is a kind of severe growth and development disorder that occurs in the infant period. It is basically characterized by social communication disorder, language development disorder, narrow area of interest, and stereotyped and repeated behavior to different extents, and is increasing in the worldwide. Education training is still taken as the major for the rehabilitation therapy of autism.OBJECTIVE: Case analysis is performed to provide elicitation for mainstreaming education training of children with autism and proper suggestions for education worker and children patients' parents.DESIGN: Case analysis.SETTING: Department of Rehabilitation, Nanjing Technical College of Special Education; Nanjing Shangxinhe Primary School.PARTICIPANTS: One male child patient, born in June 1998, was diagnosed as autism by Shenyang Children's Hospital. They met the diagnostic criteria of infantile autism of the 4th edition of diagnostic and statistical manual of mental disorders (1994, USA).METHODS: Comprehensive intervention was performed in the child with autism for 5 months. Education measures consist of: ① to well accept class learning. ② showing merits in class. ③ to well apply learning contents in life. ④ to establish friendship. ⑤ to establish good behaviors and eliminate abnormal behaviors. ⑥ to pay more attention in class.⑦ to train the perceptivity in class. ⑧ to choose proper examination methods. ⑨ to establish pleasant and confluent plate time. The procedures were as follows: we had one telephone interview to the teachers and parents of child patient every day, one face-to-face communication with the teachers, parents and classmates of child patient every week. Education strategy was regulated in time aiming to the concrete condition of child patient.Wechsler Intelligence scale was used to measure the intelligence quotient (IQ) at the beginning and end of the experiment. The changes in behavioral performance in class and playtime of patient were summed up.MAIN OUTCOME MEASURES: ① The measurement results of Wechsler IQ of patient at the end of the experiment. ② Changes in the behavioral performance of patient in class. ③ Changes in the behavioral performance of child patient in playtime.RESULTS: ① Measurement results of Wechsler IQ of patients at the end of the experiment were as follows: verbal IQ 80 points, performance IQ 110 points, full scale IQ 95 points. There was 30-point discrepancy between performance IQ and verbal IQ, and 9 points between the highest and lowest scores. The imbalance of intelligence development had turned better.② Changes in behavioral performance in class: The child patient was basically the same as other children. He could attend a class silently, followed the teacher to learn, did not disturb class, and show his brilliance with proper style. ③ Changes in the behaviors in playtime: made friends; was interested and participated in the games of the classmates, entered the classroom when he heard the ring without the help from the teacher.CONCLUSION: After 5-month rehabilitation training, the mainstreaming status of patient with autism is significantly improved as compared with before intervention. Application of various rehabilitation-training methods can improve the education effect of patient with autism.

Objective To evaluate central pancreatectomy in pancreatic surgery. Methods The clinical data of 19 patients who received central pancreatectomy was retrospectively analyzed in the Provincial Hospital, Shandong University from Jan 2002 to Jun 2008. Results Among 19 patients, 9 patients were of islet cell tumor,4 patients were mucinous cystoadenoma,3 patients were solid pseudopapilloma, 2 patients were pancreatic carcinoid tumor, 1 patient was of cyst-solid pseudopapilloma. After resection all of them had pathological negative margin. Length of stay was ( 17. 7 ± 7. 9) days ( ranging from 10 to 40 days ). Incidence of pancreatic fistula after this pancreatectomy was 31.6%. The follow-up period was from 6 months to 6 years. All of the 19 patients were alive except 1 who was lost to follow-up after 1. 5 years. There was no recurrence nor new-onset diabetes mellitus. Conclusions Middle pancreatectomy was a proper operative approach for benign or low-malignant tumors located in the neck or the body of the pancreas. This pancreatectomy may preserve endocrine and exocrine function, and decrease the risk of postoperative new-onset diabetes mellitns.

Objective To evaluate the clinical value of magnetic resonance diffusion weighted imaging (DWI)in T staging of rectal cancer.Methods Rectal cancer patients were accepted in our hospital from January 2015 to December 2015.Rectal cancer patients were examined with T2 weighted imaging (T2 WI)and magnetic resonance DWI and given preoperative T staging.The sensitivity,specificity and accuracy of T2 WI and T2 WI combined with DWI in the diagnosis of DWI staging of rectal cancer were compared,and the relationship between the apparent diffusion coefficient (ADC value)and T staging of rectal cancer was analyzed.Results The accurate rate of T2 WI in diagnosis was 65.22%(60 /92),T2 WI and DWI diagnosis accurate rate was 76.09% (70 /92).The two diagnostic methods of colorectal cancer T staging diagnosis accurate rate had no significant difference (χ2 =1.18,P >0.05). Patients with good prognosis (T2 and T3 a)ADC value were significantly higher than the patients with poor prognosis in patients with ADC (T3 b,T3 c and T4 ),and the differences were statistically significant (all P <0.05).Conclusion DWI can be used as a complementary sequence for the diagnosis of T staging of rectal cancer by T2 WI.It had better consistency with pathologic stage.The ADC value of the tumor showed a decreasing trend along with the progression of T staging of rectal cancer,and provided reliable reference information for the preoperative treatment plan.