Objective To evaluate the feasibility, effectiveness and clinical application of B ultrasound/CT-guided percutaneous radiofrequency ablation (RFA) in treating hypersplenism due to portal hypertension. Methods B ultrasound/CT-guided percutaneous radiofrequency ablation was carried out in 28 patients with hypersplenism associated with portal hypertension. Routine blood counts, liver functions and prothrombin time were determined before RFA and 2 days, 2 weeks, one, 3, 6 and 10 months after RFA separately. The results were analyzed and compared. Enhanced CT scanning reexamination was performed immediately after RFA and one week, one, 3 and 10 months after RFA separately. The volume of ablated spleen tissue was calculated with CT post-processing software. Results The mean operation time was (3.8 ± 1.1) hours and the mean ablation time was (2.7 ± 0.8) hours. The ablated volume of the spleen accounted for 20% - 80% of the whole spleen, with a mean of 50.5% ± 10.3%. Two days after RFA, the platelet count decreased to (19.5 ± 12.1) × 109/L, while the white blood cell count reached its peak value of (5.4+0.2) × 109. From two weeks to 10 months after RFA the white blood cell counts and platelet counts, the liver function, and the prothrombin time were significantly improved when compared with preoperative ones, and the differences were statistically significant (P < 0.05). Pathologically, hepatic proliferation could be seen within the cirrhotic liver after RFA. Child-Pugh score was grade A in all patients except one patient with Child-Pugh grade C who developed abdominal distention and bloody ascites after RFA. No other severe complications occurred. Conclusion For hypersplenism due to portal hypertension, B ultrasound/CT-guided percutaneous radiofrequency ablation is a safe, effective and minimally - invasive treatment.

Objective To investigate the correlation between hypoglycemia and brain injury of newborns.Methods Medical records and follow-up data of 110 newborns with hypoglycemia (blood glucose level≤2.2 mmol/L) who admitted into neonatal department of Peking University First Hospital from December 2006 to December 2009 were studied.All patients were divided into 3 groups:no brain injury group,mild and severe brain injury group according to their clinical manifestation,cerebral radiological characteristics and cerebral functional tests.By using receiver operating characteristic (ROC) curve and x2 test,the potential optimal blood glucose level and duration of hypoglycemia for predicting brain injury were confirmed.Multivariate Logistic regression was taken to determine independent predictors for brain injury.The analyzed factors included gender,preterm/small for gestational age,hyperbillirubinemia,fetal distress,asphyxia,infection,seizures and maternal hypertensive disorder complicating pregnancy and hyperglycemia.Results Among the 110 hypoglycemia newborns,33 (30.0％) infants suffered from brain injury,of which 23 were mild and 10 were severe.Blood glucose ≤1.7 mmol/L had high specificity (73％) and sensitivity (60％)for predicting brain injury.When blood glucose≤ 1.7 mmol/L,the incidence of brain injury and severe brain injury was 43.6％ (24/55) and 18.2％ (10/55),which was higher than those [16.4％(9/55) and 0.0％ (0/55)] of patients whose glucose level ＞1.7 mmol/L(x2 =9.74 and 11.00,P＜0.01 respectively).Blood glucose ≤ 1.2 mmol/L had high specificity (100％) and sensitivity (81％) for predicting severe brain injury.When blood glucose ≤1.2 mmol/L,the incidence of severe brain injury was higher than that of the patients whose glucose level was higher than 1.2 mmol/L [34.5％ (10/29) vs 0.0％ (0/81),x2 =30.72,P＜0.01].Duration of hypoglycemia ≥12 h had specificity (100％) and sensitivity (36 ％) for predicting brain injury.When duration of hypoglycemia ＜12 h,the incidence of brain injury was lower than that of the patients whose duration of hypoglycemia≥12 h [21.4％ (21/98) vs 6/6,x2 =27.69,P＜0.01].Multivariate Logistic regression showed that fetal distress (OR=4.69,95％CI:1.47-14.97,P=0.009),glucose level≤1.2 mmol/L (OR =5.16,95％CI:1.56-17.03,P=0.007),duration of hypoglycemia≥12 h (OR=8 885 220 297.12,95％CI:0.00-∞,P =0.000) and maternal hyperglycemia (OR =3.34,95％CI:1.01-11.02,P=0.048) were independent risk factors for neonatal brain injury.Conclusions Low blood glucose level and prolonged hypoglycemia might induce injury of neurol system.Fetal distress and maternal hyperglycemia might increase the incidence of brain injury in newborns with hypoglycemia.

OBJECTIVE:To strengthen the supervision of clinical antibiotics use through establishing electronic consultation system. METHODS:Based on hospital information system(HIS)and antibiotic management system,consultation system for anti-biotics of special use(ASU)was established,and the effects of the system after used(Jan. 2014)were also evaluated. RESULTS:Real-time consultation of ASU medical orders and related consultation results inquiry and statistics could be achieved through de-signing ASU consultation application form,establishing consultation experts and confirming their working content,adding statistics function,etc. The consultation have been finished 8275 times from 2014 to 2015. The inspection rate for pathogenic microbes in ASU patients rose from 78.68% in 2013 to 83.90% in 2015. CONCLUSIONS:The establishment and application of ASU consulta-tion system can improve consultation efficiency and quality,so as to promote rational use of antibiotics in the clinic.

Objective:To investigate the effects of TGF-β1 on T lymphocytes of BALB/c mice infected with Echinococcus granulosus( E.granulosus ) in vitro.Methods: The inhibitor group:the spleen cells of BALB/c mouse were co-cultured with E.granulosus and SB525334.The control group:the spleen cells of BALB/c mouse were co-cultured with E.granulosus and PBS.The blank group:the spleen cells of BALB/c mouse were co-cultured with RPMI-1640 medium and SB525334.The lymphocytes were collected at 48 h post-infection.The T lymphocyte subsets, the number of CD4+CD25+T cells, the number of NK cells, and the expression of NKG2D receptor were detected by flow cytometry.The NK cell activity was determined with the lactate dehydrogenase leakage assay(LDH).Results:The inhibition the TGF-β1 receptors resulted in the increase of in the number of CD4+T cells,the decrease in the number of CD8+T cells,the increase of in the ratio CD4+/CD8+T cells,the decrease of in the number of CD4+CD25+T cells,the increase in the expression of the NKG2D receptors,the increase in the lysis rate of Yac-1 cells by NK cells,and a positive cor-relation between the expression of activity receptor NKG2D and killing activity of NK, which were mediated by E.granulosus.Conclusion: The inhibition of TGF-β1 receptors can enhance the immune response of T lymphocytes against E.granulosus infection in vitro.

Objective: To investigate the joint effect of abdominal obesity in childhood and adulthood on adult hypertension. Methods: Based on the data from the China Health and Nutrition Survey (CHNS, 1993-2011), a total of 1 431 subjects who were investigated in both childhood (6 to17 years old) and young adulthood (18 to 35 years old) were selected for the analysis. According to waist circumference (WC) status (normal WC or abdominal obesity) in childhood and adulthood, all subjects were categorized into 4 groups. The multinomial logistic regression model was used to analyze the joint effect of abdominal obesity in childhood and adulthood on adult hypertension and pre-hypertension. Results: Compared to the subjects (n=1 057) who had normal WC in both childhood and adulthood, subjects with abdominal obesity in childhood but with normal WC (n=45) in adulthood didn′t have significantly increased risk of hypertension (OR=1.52, 95%CI: 0.19-12.06). In contrast, those who had normal WC in childhood and abdominal obesity in adulthood (n=289) had increased risk of hypertension (OR=6.48, 95%CI: 3.60-11.66). In addition, subjects with persistent abdominal obesity from childhood to adulthood (n=40) had the highest risk of hypertension (OR=15.98, 95%CI: 5.39-47.35). There was a similar trend for the association of abdominal obesity in childhood and adulthood with adult pre-hypertension, with the corresponding OR (95%CI) of 1.28 (0.66-2.49), 2.90 (2.17-3.89) and 3.49 (1.65-7.40), respectively. Conclusion The joint effect of abdominal obesity in childhood and adulthood increased the risk of adult hypertension and pre-hypertension. There was no statistical significance for subjects who had abdominal obesity in childhood but had normal WC in adulthood when compared to those with normal WC in both childhood and adulthood.

Objective:To evaluate the effect of muscle oxygen saturation (SmtO 2) guidance on the quality of early recovery after spinal surgery in the patients. Methods:One hundred and twenty patients of either sex, aged 18-64 yr, with body mass index of 18-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with Hb concentration>100 g/L, undergoing elective spinal surgery, were selected.Routine anesthesia induction and maintenance were performed.SmtO 2 monitoring was carried out, and electrodes were applied to bilateral thenar in group S. When unilateral or bilateral SmtO 2 dropped to 70% of the baseline level for more than 60 s, the sensor position was checked, fluid infusion was accelerated, vasoconstrictors was used, and the inhaled oxygen concentration was improved and blood was transfused for treatment.In group C, only electrode sheets were applied, without monitoring.The Quality of Recovery-15 scale was used to evaluate the recovery quality of patients at 1 day before operation (T 0), 1 day after operation (T 1) and 3 days after operation (T 2). The tracheal extubation time, post-anesthesia care unit stay time and postoperative length of hospital stay were recorded.Immediately before anesthesia induction and at the end of operation, arterial blood was collected for blood gas analysis, and the lactic acid level was recorded.Postoperative hypotension, constipation, spinal nerve injury, postoperative nausea and vomiting and incisional infection were recorded. Results:Compared with group C, the level of postoperative lactic acid was significantly decreased, the incidence of postoperative constipation, postoperative nausea and vomiting and incisional infection was decreased, the extubation time and post-anesthesia care unit stay time were shortened, and the Quality of Recovery-15 scale score at T 1, 2 was increased in group S ( P<0.05). Conclusions:SmtO 2 guidance can improve the early recovery quality of patients after lumbar surgery.

Cytotoxic T cells (CTLs) play a key role in the control of Hepatitis B virus (HBV) infection and viral clearance. However, most of identified CTL epitopes are derived from HBV of genotypes A and D, and few have been defined in virus of genotypes B and C which are more prevalent in Asia. As HBV core protein (HBc) is the most conservative and immunogenic component, in this study we used an overlapping 9-mer peptide pool covering HBc to screen and identify specific CTL epitopes. An unconventional HLA-A2-restricted epitope HBc141-149 was discovered and structurally characterized by crystallization analysis. The immunogenicity and anti-HBV activity were further determined in HBV and HLA-A2 transgenic mice. Finally, we show that mutations in HBc141-149 epitope are associated with viral parameters and disease progression in HBV infected patients. Our data therefore provide insights into the structure characteristics of this unconventional epitope binding to MHC-I molecules, as well as epitope specific CTL activity that orchestrate T cell response and immune evasion in HBV infected patients.
Adult ; Amino Acid Sequence ; Animals ; Binding Sites ; Epitopes ; chemistry ; immunology ; metabolism ; Female ; Genotype ; HEK293 Cells ; HLA-A2 Antigen ; metabolism ; Hepatitis B Core Antigens ; chemistry ; immunology ; metabolism ; Hepatitis B virus ; genetics ; metabolism ; Humans ; Hydrogen Bonding ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Transgenic ; Middle Aged ; Molecular Dynamics Simulation ; Mutation ; Protein Binding ; Protein Structure, Tertiary ; T-Lymphocytes, Cytotoxic ; immunology ; metabolism

Objective To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss (ISSNHL).Methods Total of 438 patients with ISSNHL,including 76 with hearing loss in low-middle frequencies,43 in middle-high frequencies,162 in all frequencies and 157 in total deafness,were randomly divided into two groups,the systemic application group:dexamethasone (DEX) was applied by intravenous injection in dose of 10 mg × 3 d followed by 5 mg ×4 d,and the topical injection group:methylprednisolone sodium succinate of 40 mg was injected into cortical bone of mastoid region every three days.According to the results of puretone threshold audiometry,the curative effect among ISSNHL with low-middle frequencies,middle-high frequencies,all frequencies hearing loss,and total deafness were evaluated.SPSS 18.0 software was used to analyze the data.Results Among 220 patients with systemic application of DEX,66 subjects (30.0％) cases were recovery,51 (23.2％) were excellent better,39 (17.7％) better,64 (29.1％) were poor,and the total effective rate was 70.9％ (156/220).There was no statistical difference in total effective rate of four typing subgroups (x2 =1.60,P ＞ 0.05).And the recovery rate in total deafness subgroup was significant lower than that in low-middle and all frequencies subgroups (x2 =10.63 and 15.94 respectively,both P ＜ 0.05).In the topical injection group,the recovery rate was 30.3％ (66 cases),excellent better 18.8％ (41),better 15.6％ (34),poor 35.3％ (77),and the total effective rate was 64.7％ (141/220).There were statistical differences of total effective rate in low-middle frequencies in comparison with that in all frequencies(x2 =8.38) and total deafness (x2 =7.28) subgroups (both P ＜ 0.05).Regarding recovery rate,there were significant differences between each two typing subgroups,except middle-high frequencies subgroup vs.all frequencies (x2 =1.60) and total deafness (x2 =2.29) subgroups (both P ＜ 0.05).In 76 ISSNHL with hearing loss in low-middle frequencies,the recovery rate in cases with local corticosteroids injection(65.0％) was significantly increased in comparison with that with systemic application (41.7％),x2 =4.15,P ＜ 0.05.There were increasing tendencies of curative effect in other three typing groups by systemic corticosteroids application when compared with local injection,but no statistical significances (all P ＞ 0.05).Conclusions For low-middle frequencies ISSNHL,the corticosteroids administration of local injection should be the optimization.Systemic application would be applied for middle-high frequencies,all frequencies and total deafness.

Objective:To investigate the effect of intraoperative blood transfusion on postoperative deep vein thrombosis in patients with orthopedic trauma.Methods:A retrospective analysis was conducted of the 502 patients who had been treated operatively at Department of Orthopaedics and Trauma, Xi＇an Honghui Hospital from January 2015 to September 2018. They were divided into 2 groups according to the use of intraoperative blood transfusion. In the observation group of 203 cases who had received intraoperative blood transfusion, there were 98 males and 105 females with an age of (61.0±20.7) years; in the control group of 299 cases who had not received intraoperative blood transfusion, there were 166 males and 133 females with an age of (57.7±19.0) years. Blood coagulation series such as D-dimer and fibrinogen were measured at admission, 1 day pre-operation, 1 day and 3 days postoperation. After operation, venous ultrasound examination of both lower limbs was performed to observe postoperative DVT in the patients. The 2 groups were compared in changes in coagulation series and occurrence of postoperative DVT.Results:There was no statistically significant difference in the preoperative general data between the 2 groups ( P>0.05), showing they were comparable. There was no significant difference between the observation group and the control group in the D-dimer level at admission or 1 day pre-operation ( P>0.05), but the D-dimer levels at 1 day and 3 days postoperation in the observation group [4.18 (2.35, 7.08) mg/L and (6.20±3.77) mg/L] were significantly higher than those in the control group [3.41 (1.91, 5.63) mg/L and (4.05±2.62) mg/L] ( P<0.05). There was no statistically significant difference in fibrinogen between the 2 groups at different time points ( P>0.05). The incidence of DVT in the observation group was 43.3% (88/203), significantly higher than that in the control group (32.8%, 98/299) ( P<0.05). Conclusion:As intraoperative blood transfusion can increase the level of D-dimer and thus the incidence of postoperative venous thrombosis in patients with orthopaedic trauma, we should pay more attention to the risk of postoperative DVT in patients receiving intraoperative blood transfusion.

Objective To evaluate the effect of transcutaneous electric acupoint stimulation (TEAS)on prognosis in the patients at high risk of postoperative pulmonary complications. Methods Sixty American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes, aged 65-72 yr, with body mass index of 18-25 kg∕m2, scheduled for elective thoracoscopic and laparoscopic radical resection of e-sophageal cancer, were divided into placebo control group(group C, n=30)and TEAS group(n=30). In group TEAS, bilateral Zusanli(ST36), Hegu(LI4)and Feishu(BL13)acupoints were stimulated for 30 min(disperse-dense waves, frequency 2∕100 Hz, intensity of currents 8-12 mA)starting from 30 min be-fore anesthesia induction.In group C, electrodes were placed on the same acupoints before anesthesia induc-tion, but no current was given.General anesthesia was performed in two groups.Before one-lung ventilation, at 30 min and 2 h of one-lung ventilation and at 1 h after operation(T1-4), blood samples were drawn from the radial artery for blood gas analysis, and oxygenation index and alveolar-arterial oxygen partial pressure difference were calculated.Blood samples were collected from the internal jugular vein at T1-3and 24 h after surgery(T5)for determination of plasma tumor necrosis factor-alpha, interleukin-6(IL-6)and IL-10 con-centrations.The development of postoperative pulmonary complications, time for removal of drainage tube and length of hospital stay were recorded. Results Compared with group C, the oxygenation index at T2-4and plasma IL-10 concentrations at T3were significantly increased, the alveolar-arterial oxygen partial pressure difference at T2,3, plasma tumor necrosis factor-alpha concentrations at T2,3, plasma IL-10 concentrations at T3,5and incidence of postoperative pulmonary complications were decreased, and the time for removal of drainage tube and length of hospital stay were shortened in group TEAS(P<0.05). Conclusion TEAS can improve prognosis in the patients at high risk of postoperative pulmonary complications.