Objective To probe the application of umbilical vein catheterization among the verylow-birth-weight or the low-birth-weight children.Methods In this retrospective study,the clinical condition of the very-low-birth-weight or the low-birth-weight infants in neonatal intensive care unit who had umbilical vein catheterization from June 2011 to January 2013 was concluded.Results Sixty-three cases were successfully catheterized,of which 41 cases were catheterized in inferior vena cava(65.1％).The retention time was 4 to 21 days,with an average of 12.9 days.Eleven cases suffered unplanned extubation of the indwelling catheters,and eight of them were located in the umbilical vein.There were statistically significant differences of unplanned extubation rates among different location of the catheters (x2 =8.38,P ＜ 0.01).All cases were intubated within 36 hours after birth,and the intubation time was not positively correlated to the success rate of catheterization in the inferior vena cava (x2 =0.223,P ＞ 0.1).Suspected catheter-related infections occurred in 5 cases and the infection rate was 6.2/1000 per intravascular catheter day.After extubation,bacterial cultures of the tips of the catheters and blood were arranged.The results suggest that the bacterial culture of the catheter tip was positive in only 1 case(1.6％),and yeast-like fungus was positive in 1 case (1.6％),while the retention time and incidence of catheter-related infection had no significant corelation(x2 =0.075,P ＞ 0.95).Conclusion Umbilical vein catheterization could be used at the early stage in preterm (very) low-birth-weight infants.

OBJECTIVE:To provide reference for promoting the application ofwhole course tutorial systemin the practice teaching of medical higher vocational colleges. METHODS:Totally 106 students on internships of medical higher vocational colleg-es were selected and randomly divided into control group(n=53)and observation group(n=53). Control group received routineteaching method;observation group receivedwhole course tutorial systemteaching method on the basis of control group. Score, teaching quality and students'satisfactory degree were compared between 2 groups after the end of internship teaching. RESULTS:The scores of autonomous learning ability,comprehensive ability,communication ability,judgment ability,thinking and solving problem ability and total score in observation group were all significantly higher than control group after the end of internship teach-ing;the proportion of good teaching quality in observation group was significantly higher than control group,manifesting as high practical ability,good adaptability,caring patient,good learning condition;the satisfactory degree of students in observation group was significantly higher than control group(98.11% vs. 88.68%),there was statistical significance(P<0.05). CONCLUSIONS:The implementation ofwhole course tutorial systemteaching method in practice teaching of medical higher vocational colleges based on conventional teaching method achieves ideal effect and can improve the students'learning effect,teaching quality and stu-dents'satisfactory degree.

Objective To analyze blood type unexpected antibody and disease characteristics of inpatients in a hospital,and provide a reference for optimizing precise transfusion schemes and improving clinical transfusion safety.Methods The data of unexpected antibody screening and identification in the General Hospital of Western Theater Command from January 2012 to December 2021 were collected,while information on these patient age,gender,blood transfusion history,pregnancy history and disease diagnosis were also collected.The positive rate,composition ratio and disease characteristics of unexpected antibodies were analyzed.Results The positive rate of unexpected antibody screening was 0.55%(1 736/315 456),in which females were higher than males(0.69%vs 0.44%,χ2=90.107,P＜0.05),patients with a history of blood transfusion or(and)pregnancy were higher than those without a history of blood transfusion or(and)pregnancy(75.69%vs 22.81%,χ2=971.098,P＜0.05),and patients aged 40～80 accounted for 72.93%(1 266/1 736).Patients diseases with unexpected antibody positive accounted for 80.41%(1 396/1 736),mainly including digestive system diseases,immune diseases of blood and hematopoietic organs,tumors,urogenital system diseases,circulatory system diseases,musculoskeletal system and connective tissue diseases.Moreover,91.88%(1 595/1 736)of the patients with anti-screening positive underwent antibody identification,in which the majority of unexpected antibodies were Rh blood group system[41.57%(663/1 595)],Lewis blood group system[11.22%(179/1 595)],and MNS blood group system[6.90%(110/1 595)].Antibody specificity was mainly characterized by anti-E[32.41%(517/1 595)],anti-Lea[10.47%(167/1 595)],and anti-M 6.08%(97/1 595).Other antibodies[35.8%(571/1 595)]were mainly no-detected specific antibodies.Conclusion The screening results of blood type unexpected antibodies and disease type analysis are of great significance for transfusion safety.Blood transfusion department should carry out precise blood transfusion matching with multiple antigens(RhCcDEe,Lea,M)for long-term transfusion patients,women,and patients with pregnancy or blood transfusion history,so as to reduce the incidence of unexpected antibodies and improve transfusion safety.

Objective To explore rationale and clinical application of simplified modified radical thyroideetomy for differentiated thyroid carcinoma.Methods From Jan.2007 to Jun.2010,349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy.The simplified procedure took a low small collar incision(about 10-12 cm).In separating upper and lower skin flaps,subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoeleidomastoid muscle were spared to protect sensory nerves.Subtotal thyroidectomy Was performed to resect the affected lobe,isthmus,and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened.Soft tissues of the mainly metastatic areas(Ⅱ a、Ⅲ、Ⅳ、Ⅴb)were cleared.The accessory nerve was not exposed routinely to avoid stimulation.Lymph nodes metastasis in different areas was recorded respectively.Complications in different operative modes were compared.Results Compared with standard modified radical thyroidectomy,the simplified mode had shorter scar-and no limit of neck mobility.Because of muscles and nerves pemervation,movement dysfunction and abnormal sensation of neck and shoulder decreased obviously.The operation duration was shortened.Cervical lymph node status Was evaluated,which provided basis for prognosis judgment and comprehensive treatment.Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy.It improvs the life quality of patients.This procedure fits the principle of functional radical neck dissection better.

Objective To compare the effectiveness and safety of ultramini percutaneous nephrolithotomy (UMP) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized (about 1-2 cm) renal lower caliceal calculi.Methods From March 2015 to December 2016,patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed.Patients were randomized into two groups according to the random number table.Group UMP's operational channel was only F14 and the nephroscope's diameter was 1 mm.200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent.In Group RIRS,all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared.Results 100 patients were enrolled in the study 50 patients in Group UMP,28 were male and 22 were female,mean age was 43.4 ± 7.9 years old.Mean stone size was 14.5 ±3.0 mm(range 10-22 mm).Among them,18 cases were complicated with mild and moderate hydronephrosis.The other 50 cases were allocated to Group RIRS,including 31 males and 19 females.Their mean age was 44.5 ± 8.3 years old and mean stone size was 13.7 ± 3.1 mm (range 10-21 mm).Among them,16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups (P ＞ 0.05).After three months' follow-up,one-time stone free rate(SFR) of UMP group was 94.0％ (47/50),which was significantly more superior than the 72.0％ (36/50) of the RIRS group(P ＜ 0.05).The intraoperative decrease in hemoglobin were (7.8 ± 3.3) g/L vs.(3.1 ± 3.4) g/L,and operating time(26.5 ± 6.1) min vs.(43.3 ± 6.3) min.Significant differences were also seen between the two groups(P ＜0.05).There was more blood loss and less operating time in the group of UMP.The hospital stay,delayed hemorrhage and postoperative fever between the UMP and RIRS groups were (4.3±1.3)d vs.(3.24 ± 1.21)d,8.0％ (4/50)vs.0(0/50),16.0％ (8/50)vs.12.0％ (6/50) respectively.No significant differences were seen (P ＞ 0.05).Conclusions Both UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi.Compared with RIRS,UMP may be more effective and has less operating time,however wtih more intraoperative blood loss.

Objective:To investigate the distribution of pathological types of unilateral primary aldosteronism, and to explore the clinical characteristics and prognosis of patients with different pathological types.Methods:A total of 241 patients with unilateral primary aldosteronism who underwent adrenal surgery were included in this study. The clinical data and postoperative follow-up data were collected, and the postoperative tissue sections were stained with HE and aldosterone synthase. According to the staining results, pathological types of 241 patients were classified, and the clinical characteristics and surgical prognosis of patients with unilateral primary aldosteronism were compared.Results:According to the international histopathology consensus for unilateral primary aldosteronism, among 241 patients with unilateral primary aldosteronism, 223 were classical(92.5%), 17 were non-classical(7.1%), and 1 was aldosterone producing carcinoma(0.4%). Among classical cases, 189 were aldosterone producing adenoma and 34 were aldosterone producing nodule. In the non-classical cases, 8 cases were multiple aldosterone producing nodule and 9 cases were multiple aldosterone producing nodule. Compared with the classical group, the non-classical group had a longer duration of hypertension(9.0 vs 5.0 years, P=0.062) and a lower baseline plasma aldosterone concentration(273 vs 305 pg/mL, P=0.147), but the difference was not significant. There was no significant difference between the two groups in the proportion of patients who achieved a complete biochemical response after surgery(98% vs 92.3%, P=0.281), but the proportion of patients who achieved a complete clinical response was significantly lower in the non-classical group(23.1% vs 52.9%, P=0.046). Conclusion:The pathological types of unilateral primary aldosteronism are predominantly classical, with aldosterone-producing adenoma being the most common. There were no significant differences in the clinical characteristics and postoperative biochemical remission rates between classical and non-classical patients, but the clinical prognosis of the latter was inferior to the former.

Primary aldosteronism(PA) is one of the most common secondary hypertension, the pathogenesis is still not fully understood. Aldosterone synthase(CYP11B2) was thought to be continuously expressed in the zona glomerulosa of the adrenal cortex. In recent years, it is found that there were discontinuous CYP11B2 positive cell clusters in adrenal cortex via immunohistochemical staining, and proposed the concept of aldosterone-producing cell clusters(APCC). Thenceforwarding a growing body of studies suggest that there may be a potential causal link between APCC and PA. This article summarizes the latest studies on APCC and provide an update on the potential role of APCC in the pathogenesis of PA.

Objective:To evaluate the safety and efficacy of LVIS stent-assisted coil embolization in the acute phase of ruptured intracranial aneurysms.Methods:The clinical data of 55 patients with ruptured intracranial aneurysm treated with LVIS stent-assisted coil embolization admitted to Zhongshan Hospital of Xiamen University from January 2016 to December 2018 were analyzed retrospectively. The general data, the characteristics of aneurysms and the occurrence of perioperative complications of the patients were collected. The clinical prognosis of the patients at discharge and 6 months of follow-up was recorded. The Glasgow prognosis score (GOS) was graded as good (5), average (3-4), and poor (1-2), and the cerebral angiography results were recorded immediately after embolization and 6-month follow-up. The aneurysm occlusion was assessed by Raymond grade, Raymond Ⅰ was complete obliteration, Ⅱ was residual neck and Ⅲ was residual aneurysm.Results:All 55 patients received LVIS stent-assisted coil embolization within 72 hours of ruptured intracranial aneurysms, and all stents were released successfully, including 16 males (29.1%) and 39 females (70.9%). The median age was 53 (24-80) years old. Anterior circulation aneurysms were found in 49 patients (89.1%) and posterior circulation aneurysms in 6 patients (10.9%). According to Hunt-Hess classification, there were 43 patients with grade Ⅰ-Ⅱ (78.2%), 7 patients with grade Ⅲ (12.7%) and 5 patients with grade Ⅳ-Ⅴ (9.1%). The first digital subtraction angiography (DSA) examination of 55 patients after embolization showed that 41 patients had complete obliteration of aneurysms and 14 had residual neck; and the smaller the aneurysm was, the higher the rate of complete obliteration after embolization was. The proportion of small aneurysms (maximum diameter ≤ 7 mm) in the complete obliteration group was significantly higher than that in the neck residual group (100.0% vs. 64.3%, P < 0.01). Among the 55 patients, there was 1 patient suffered from in-stent thrombosis during embolization, 1 patient suffered from distal vascular thrombosis induced by plaque shedding during embolization, 1 patient suffered from vasospasm during embolization, and 1 patient suffered from postoperative distal cerebral hemorrhage after embolization. In 2 dead patients, 1 died of cardiogenic disease and 1 died of respiratory failure caused by severe pneumonia. At discharge, the prognosis was good in 40 patients, average in 10 patients, and poor in 5 patients; and the higher the Hunt-Hess grade at admission, the worse the prognosis. The proportion of patients with Hunt-Hess grade Ⅰ-Ⅱ at admission in the good prognosis group was significantly higher than that in the general prognosis group and the poor prognosis group (90.0% vs. 50.0%, 40.0%, P < 0.01). Of the 55 patients, 39 completed clinical prognosis and cerebral angiography 6 months after embolization for follow-up. All patients had GOS no less than 3, including 32 patients with complete obliteration of aneurysm, 4 with residual neck and 3 with residual aneurysm. The smaller the aneurysm, the higher the rate of complete obliteration at 6-month follow-up was. The proportion of small aneurysm in the complete obliteration group was significantly higher than that in the residual neck group and the residual aneurysm group (100.0% vs. 75.0%, 33.3%, P < 0.01). There was no rebleeding or ischemic complication at 6-month follow-up. Conclusions:LVIS stent assisted coil embolization is safe, effective and feasible in the acute stage of ruptured intracranial aneurysms. Standardizing antiplatelet therapy and dense packing of aneurysms during embolization are the key to reduce bleeding and ischemic complications.

Objective:To explore the early predictive value of umbilical cord blood S100β protein and lactate combined with amplitude integrated electroencephalogram（aEEG）in small for gestational age（SGA）preterm infants with brain injury.Methods:One hundred and six cases of SGA preterm infants were enrolled in this study in Neonatology Department of Inner Mongolia People's Hospital from January 2019 to December 2021. Umbilical cord blood serum S100β protein and lactate at birth of All SGA preterm infants were tested，and aEEG was monitored at 6h and 72 h after birth，corrected gestational age of 32 weeks and 37 weeks. According to the diagnostic criteria of brain injury in preterm infants，SGA preterm infants were divided into brain injury group（45 cases）and non-brain injury group（61 cases），and compared the differences of S100β protein，lactate and the designated time aEEG between the two groups.SGA preterm infants with brain injury were further divided into symmetrical group（28 cases）and non-symmetrical group（15 cases）. The differences of umbilical cord blood S100β protein and lactate level between the two groups were compared，and the diagnostic value in different types of SGA preterm infants with brain injury was also compared.Results:SGA preterm infants in the brain injury group had significantly higher levels of umbilical cord blood S100β protein［（0.826±0.218）μg/L vs（0.397±0.196）μg/L， t=8.316， P<0.05］and lactate［（8.5±1.3）mmol/L vs（3.8±0.9）mmol/L， t=3.281， P<0.05］than those in non-brain injury group.Symmetric SGA group had higher level of S100β protein than the asymmetric SGA group［（0.924±0.205）μg/L vs（0.438±0.196）μg/L， t=5.734， P<0.05］.But there was no statistically significant difference in lactate levels［（5.6±1.4）mmol/L vs（3.9±1.2）mmol/L， t=0.932， P>0.05］between symmetric SGA group and asymmetric SGA group. The abnormal rates of aEEG in brain injury group and non-brain injury group were respectively 100%（45/45）vs 22.95%（14/61）at 6 h after birth，95.56%（43/45）vs 16.39%（10/61）at 72 h after birth，62.22%（28/45）vs 6.56%（4/61）at 32 weeks of corrected gestational age，22.22%（10/45）vs 3.28%（2/61）at 37 weeks of corrected gestational age. The abnormal rate of brain injury group was higher than the non-brain injury group in the same nodal time，and the differences were statistically significant（ χ 2 value respectively 62.292，64.913，38.074，9.257，all P<0.05）. Conclusion:There were significant value in umbilical cord blood S100β protein，lactate level and aEEG monitoring in the early diagnosis in preterm infants SGA with brain injury. The combination of the three might be more helpful for the early diagnosis and timely treatment of brain injury in SGA preterm infants.