Hepatic cavernous hemangioma is the most common benign tumor of liver.Hepatic artery embolism chemotherapy is one of the commonly used treatment methods,but more and more related complications and sequelae have been reported recently,including obstructive jaundice caused by damaged biliary tract.Because the symptoms are not typical,obstructive jaundice might be misdiagnosed as malignant biliary tumor,which brought troubles to subsequent treatment.In this article,the clinical data of 2 patients with obstructive jaundice following transcatheter hepatic arterial chemoembolization for hepatic cavernous hemangioma were retrospectively analyzed,and the experience in the diagnosis and treatment of this disease was summarized.

Objective To study the constituents of Abrus mollis.Methods The constituents were isolated by chromatographic methods,their structures were elucidated by spectroscopic evidences.Results Eleven compounds were purified and their structures were identified,they were identified as ?-sitosterol(Ⅰ),stigmasterol(Ⅱ),nonacosanyl caffeate(Ⅲ),daucosterol(Ⅳ),betulinic acid(Ⅴ),vanillic acid(Ⅵ),inositol methyl ether(Ⅶ),sucrose(Ⅷ),soyasaponin Ⅰ(Ⅸ),kaikasaponin Ⅲ(Ⅹ),and dehydrosoyasaponin Ⅰ(Ⅺ).Conclusion Compounds Ⅰ,Ⅲ,Ⅳ,Ⅵ,and Ⅶ-Ⅺ are isolated from this plant for the first time.

Objective To investigate the diagnostic value of 64-slice CT angiography (CTA) to head and neck artery pathological changes.Methods One hundred patients with clinical suspicion of head and neck vascular lesions were retrospectively analyzed.Sixty four cases of lesions were detected by 64-slice CTA,and were checked by Digital Subtraction Angiography (DSA) within a week.First,the correlation of 64-slice CTA and DSA diagnosis of head and neck artery stenosis grade was counted.Then DSA was taken as the gold standard.The sensitivity,specificity,positive predictive value,and negative predictive value of 64-slice CTA to diagnose head and neck arteries stenosis were calculated.Results Of 64 cases of patients,2 cases of congenital vascular dysplasia,including 1 case with internal carotid artery in 2 cases,the remaining 60 patients had different degree of stenosis.The sensitivity,specificity,positive predictive value,and negative predictive value of 64-slice CTA was 95.34％,99.48％,97.62％,and 98.98％,respectively.Among 60 narrow patients,the plaque number was 205,including 88 soft plaques,56 mixed plaques,and 61 calcified plaque.Conclusions The 64-silce CTA has multiple advantages including rapid,noninvasiveness,high accuracy and safety,and high application value in the diagnosis of head and neck vascular lesions.It is worth promoting.

Objective To investigate the effect of transplanted bone marrow stromal cells on the cells in the subventricular zone of the rats with permanent focal cerebral ischemia and analyze cell types.Methods Permanent focal cerebral ischemia models were established with middle cerebral artery occlusion(MCAO) and divided into three groups: MCAO alone,intravenous infusion of 1ml PBS at 24 hours after MCAO,and intravenous infusion of 2?106 BMSCs 24 hours after MCAO.Then,the groups were subdivided into 7-day and 14-day groups after MACO.Neurological functions were detected by Zausinger evaluation;meanwhile,5-bromodeoxyuridine was injected to label the proliferating cells in the subventricular zone,and double-immunofluscent technologies were used to identify the cell type.Results On the 7th day and the 14th day after MACO,neurological functional scores of BMSCs-treated group were higher than those of the other two groups(P

This paper analysed the rhinoscope's clinical value in microsurgical treatment of intracranial aneurysms. Application of the rhinoscope in 87 patients, only 2 patients had ruptured during operation. However, 11 cases had ruptured in 94 cases without using rhinoscope, P < 0.05, they had a significant difference. By DSA follow-up review, 82 cases of used rhinoscope only 2 cases had remained the aneurysm neck, but 9 cases had the aneurysm neck in 77 cases which had not used the rhinoscope in the microsurgical treatment, P < 0.05, they also had significant difference. The application of rhinoscope in microsurgical treatment of intracranial aneurysms intraoperative, can reduce the risk of the intraoperative aneurysm rupture. It can achieve better clinical effect.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Microsurgery ; Middle Aged ; Nose ; surgery ; Treatment Outcome

Objective To investigate the distribution and antimicrobial resistance profile of clinical gram-negative bacterial isolates in the First Afifliated Hospital of Nanjing Medical University during 2014.Methods Bacteria identiifcation was performed by API system or the VITEK-2 Compact automatic identiifcation system. Disk diffusion susceptibility testing or VITEK-2 Compact automatic identification system was used to determine the susceptibility to antimicrobial agents. All data were analyzed using WHONET 5.6 software.Results Among the total 7 931 clinical isolates in 2014, gram-negative bacteria accounted for 64.2% (5 088/7 931). The top three pathogens wereE. coli,A. baumannii andK. pneumoniae. Notably, during the year 2014, 195 strains of carbapenem-resistantEnterobacteriaceaewere isolated, about 6.9% of all theEnterobacteriaceae isolates. Meanwhile, 613 (66.5%) strains of multiple drug resistantA. baumannii and 197 (28.7%) strains of multiple drug resistantP. aeruginosa were isolated.Conclusion During the year 2014, the resistance of the gram-negative bacteria in this hospital is mainly characterized by carbapenem-resistantEnterobacteriaceae, multiple drug resistant A. baumanniiand multiple drug resistantP. aeruginosa. Surveillance of antimicrobial resistance is beneifcial for rational use of antibiotics.

BACKGROUND:Surgical treatment for pigmented vil onodular synovitis can maximize the excision of synovial lesions and recovery of joint function.
OBJECTIVE:To investigate the knee joint function and relapse rate fol owing treatment of pigmented vil onodular synovitis with total knee replacement and arthroscopic synovectomy.
METHODS:We retrospectively analyzed 34 cases of knee pigmented vil onodular synovitis admitted for surgical treatment in the Department of Orthopedics, Xiangya Hospital of Central South University, China from December 2006 to December 2011. In these cases, 24 patients received arthroscopic synovectomy and 10 patients were subjected to total knee replacement. Adjuvant radiotherapy was conducted according to postoperative patient’s conditions. Lysholm scoring was employed in the arthroscopic synovectomy group, and American Knee Society scoring was used in the total knee replacement group. Knee function in two groups was compared before and after treatment. Fol ow-up observation was performed to compare knee function recovery and relapse rate between two groups.
RESULTS AND CONCLUSION:Thirty-four patients were effectively fol owed up for 12-66 months, mean 41.3 months. Statistical analysis showed that in the arthroscopic synovectomy group, the postoperative Lysholm score was (86.3± 10.3) points, significantly higher than the preoperative score which was (55.5±13.2) points (t=3.81, P=0.016, P<0.05). In the total knee arthroplasty group, the American Knee Society score was increased from (40.7±2.2) points preoperatively to (90.2±1.1) points postoperatively (t=6.27, P<0.01). In the arthroscopic synovectomy group, the American Knee Society score was increased from (34.2±3.9) points preoperatively to (80.8±1.9) points postoperatively (t=16.58, P<0.01). Arthroscopic synovectomy combined with adjuvant radiotherapy can achieve better outcomes in pigmented vil onodular synovitis patients, while the total knee replacement for advanced with advanced knee diffuse pigmented vil onodular synovitis is better to restore knee function and the recurrence rate is low.

Objective:To evaluate the value of vasoactive-inotropic Score (VIS) at different time points in predicting the 28-day mortality of patients with septic shock, so as to reduce the risk of death and improve the prognosis of patients.Methods:This experiment was a single-center retrospective cohort study. The clinical data of 275 adult patients with septic shock who were treated with vasoactive drugs in the intensive care unit of the Affiliated Hospital of Xuzhou Medical University from February 2016 to February 2020 were collected. According to the 28-day survival condition, all recruited patients were divided into the death group and the survival group, and the maximum vasoactive-inotropic score of all patients at the first 24 h and the second 24 h were calculated, which were expressed as VIS max24 and VIS max48. Multivariate logistic regression analysis was used to find the independent risk factors that influencing the prognosis. The receiver operating characteristic curve was used to analyze the predictive value of VIS. Results:There was no significant difference between the death group and the survival group in the characteristics including age, sex, weight, infection sites, blood culture results, cardiac arrest, hormone use, and 24 h rehydration volume ( P>0.05). APACHE II score, basic lactic acid, and lactic acid after 24 h of treatment were increased significantly in the death group ( P<0.05). VIS max24 could accurately predict the 28-day mortality (AUC=0.953, 95% CI: 0.924-0.982), which were more efficent compared to VIS max48 (AUC=0.919, 95% CI: 0.881-0.957), basic lactic acid (AUC=0.937, 95% CI: 0.900-0.966) and APACHEⅡ score (AUC=0.865, 95% CI: 0.818-0.913). Conclusion:VIS max24 can more accurate predict the 28-day mortality in patients with septic shock.

Objective To analyze the effects of quality supervision and continuous improvement system on optimizing in-hospital diagnosis and treatment process in patients with acute ischemic stroke (AIS).Methods From September 2013 to May 2016,424 consecutive patients with AIS treated with intravenous thrombolysis and/or endovascular therapy in Changhai Hospital,the Second Military Medical University were enrolled retrospectively.They were analyzed according to the annual running process (the first year[from September 2013 to August 2014],the second year[from September 2014 to August 2015],and the third year[from September 2015 to May 2016]).The spend time and delay (DTN>60 min,DTP>90 min) rate of each treatment process in the first,second,and third year (time from door-to-imaging[DTI],door-to-needle[DTN],imaging-to-needle (ITN),door-to-groin puncture (DTP) and imaging-to-groin puncture (ITP) were compared.Taking the time periods (>median) of having significant differences of the spend time of the treatment processes as the dependent variables in the first,second,and third year,the influence of the years and treatment modalities on delay was observed.The difference of constituent ratio of the reasons for delay in intravenous thrombolysis and endovascular therapy (objective reasons/other reasons) in different years were analyzed.Results (1) DTIs were 23.0 (11.0,42.0) min,22.0 (10.1,39.0) min,and 13.0 (6.0,27.0) min,respectively,and DTNs were 50.0 (30.0,77.1) min,45.0 (30.0,70.2) min,and 36.0 (24.0,57.0) min,respectively in the first,second,and third year.The spending time was shortened year by year.There were significant differences among the different years (all P<0.01).The spending time of DTP had a tendency to be shortened,but there were significant differences among different years (P=0.06).There were no significant differences between the spending time of ITN and ITP (all P>0.05).(2) The DTN delay rates were 33.3% (40/120),20.7% (29/140),and 8.1% (9/111),respectively in the first,second,and third year.There were significant differences among the 3 years (x2=22.111,P<0.01).There were no significant differences among the DTP delay rates (P=0.08).(3) Multivariate Logistic regression analysis showed that taking the first years as a reference,the risk of DTI delay was reduced in the third year (OR,0.174,95%CI 0.101-0.298,P<0.01),the risks of DTN delay were reduced in the second and third year (OR,0.564,95%CI 0.338-0.941;OR,0.180,95%CI 0.101-0.320,all P<0.05).For simple intravenous thrombolysis,bridging therapy was a protective factor for the improvement of treatment efficiency in the DTI process (OR,0.530,95%CI 0.297-0.943,P=0.031).Compared with the bridging therapy,the direct endovascular therapy was a protective factor for DTP treatment (OR,0.427,95%CI 0.202-0.901,P=0.025).The remaining independent variables were not associated with the occurrence of DTN and DTP delay (all P>0.05).(4) During the three years,the delay of intravenous thrombolysis was mainly due to objective reasons.The constituent ratio of other reasons caused delay of intravenous thrombolysis was decreased year by year.There was no other reasons for delay in the third year).There was no significant difference in the constituent ratio of the delay reasons in endovascular treatment (x2=3.622,P=0.164).Conclusion Under the existing process and resource allocation,setting the DTN target time and implementing continuous quality improvement are conducive to the effective implementation of brain CT scan and continuous optimization of intravenous thrombolysis in the processes in AIS patients with the first diagnosis.

Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.