Objective:To study the clinical effect and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of liver cirrhosis with esophageal variceal bleeding.Methods:86 cases of cirrhotic patients with esophageal and gastric varices bleeding admitted in our hospital from August 2013 to April 2015 were selected and randomly divided into the control group and the observation group with 43 cases in each group.The control group underwent percutaneous transhepatic coronary vein embolization (PTVE) treatment,while the observation group were treated with TIPS.The success rate of surgery,the incidence of various complications,the long-term survival rate and the symptoms and the changes of liver function after operation were compared between the two groups of patients.Results:The portal vein pressure after operation in the observation group was significantly lower than that of the control group (P=0.00),at 3 months,6 months and 12 months after operation,the rebleeding rate in the observation group were significantly lower than that of the control group (P＜0.05),but the incidence of hepatic encephalopathy showed no significant difference between the two groups (P＞0.05);before operation and at 6 months and 12 months after operation,the Child-Pugh score,serum TBIL,DBIL levels showed no significant difference between the two groups (P＞0.05),at 3 months after operation,the Child-Pugh score,serum TBIL,DBIL levels in the observation group were significantly higher than those of the control group (P＜0.01);the 1 year survival rate showed no significant difference between two groups (P=0.72).Conclusion:TIPS could effectively improve the symptoms of varicose veins,better on liver function damage,and enhance the long-term survival high rate with high safely in the treatment of esophageal variceal bleeding in patients with cirrhosis.

Objective: To investigate the prophylactic effect of EEN on pulmonary infection in patients with severe traumatic brain injury.Methods: 60 cases of young adults with severe brain injury were randomized into the early enteral nutrition group(experimental group) or the control group.The experimental group was feeded 12～24 hours after injury or surgery and the control group was feeded 24 h～5 d after injury or surgery.The double-sugar test method was used for determination of intestinal barrier function,and the duration of pulmonary infection was recorded.Results: The lactulose/mannitol ratio in experimental group was significantly lower than in control group on the 7th postoperative day.The average body temperature and duration of pulmonary infection in experimental group were significantly lower than in control group.According to ADL scores,the daily capacity of convalescent patients in experimental group was significantly better than in control group.Conclusion: The early enteral nutrition can improve mucosal barrier function,reduce the incidence of pulmonary infection and improve overall prognosis in patients with severe traumatic brain injury.

Objective To analyze the psychological condition of postgraduates in clinical hos-pitals of colleges and universities before and after the implementation of psychological mentor scheme so as to evaluate the effect. Methods Quantitative questionnaire (SCL-90 scale) and qualitative fo-cus interview were used to compare psychological condition of postgraduates. Totally 182 copies of questionnaires were sent to two hospitals (A and B) respectively. Then, psychological mentor scheme was carried out in A hospital. Afterwards, 206 and 140 copies of questionnaires were sent again to the hospitals respectively to compare the results. Eight student psychological consultants, 12 postgraduates and 5 postgraduate management staff were enrolled in qualitative focus interview. Excell2003 software was adopted to establish the database and SPSS 11.0 software was used for statistical analysis. Descrip-tive analysis, frequency analysis, t test, chi-square test and variance analysis were adopted for data analysis. P<0.05 signifies for statistically significant difference. Results Mental health status of both groups was better than the national level before the implementation (total SCL score: A hospital=118 . 08 ±36.20; B hospital =100.33 ±22.90). However, SCL-90 score of A hospital was decreased (total SCL score: 102.58 ±25.23) and that of B hospital (total SCL score:134.01 ±38.92) was in-creased (part of items higher than the adult national norm) at one year after conducting psychological mentor scheme. Conclusions Psychological mentor scheme can effectively relieve stress and interper-sonal stress so as to reduce the general psychological problems and can help to improve mental health of the students.

Objective To investigate the strategies of reducing the incidence of missed diagnosis of severe traumatic brain injuries combined with multiple trauma. Methods Data of 432 patients with severe traumatic brain injuries and multiple trauma (ISS≥20) from January 2000 to August 2007 were analyzed retrospectively. All patients were divided into missed diagnosis group (MD group, n =54) and non-missed diagnosis group (NMD group, n =378) for correlation analysis on ISS, GCS, anatomical locations of the missed diagnosis, the time of delayed diagnosis and the prognosis. Results ISS was (42.97±10.94) points in MD group, with statistical difference compared with NMD group (P < 0.05). The patients with GCS≤8 in MD group was more than those in NMD group (P < 0.05). Conclusions It is effective to prevent missed diagnosis and improve the survival of patients with severe traumatic brain injuries combined with multiple trauma by judging injury severity quickly and precisely based on the principle of "life first" and repeated and systemic physical examination.

Objective To study the effect of BCL-2 ?-radiation on BCL-2 gene in dogs, and its relationship and signifcane on apoptosis of proliferated smooth muscle cells of bile duct wall. Methods The ~(103)Pd (radioactivity) stent(experiment group) or ordinary stent(control group) was positioned into the target segment of bile duct. The injured bile duct segments were dissected free from the dogs, and BCL-2 gene in the (control) and r-radiation-induced apoptotic smooth mucle cells of bile duct wall was analysed by using (immuno-histochemical) technique. The number of apoptotic cells was counted, and size of lumen of bile duct in both groups was measured by a computerized imaging system.Results BCL-2 gene expression was weaker in the ~(103)Pd radioactive stent group than in the ordinary stent group. The group of dogs with low expression of BCL-2 genes showed marked apoptosis of proliferated smooth mucle cells of bile duct and there was no overt stenosis of extrahepatic bile ducts. The group that showed high expression of BCL-2 gene did not show marked apoptosisi of proliferated smooth muscle cells of bile duct, and there was marked stenosis of extrahepatic bile duct.Conclusions The expression level of BCL-2 in experimental dogs is related to the develoment of (cellular) apoptosis and to radiation sensitivity of the cells. ~(103)Pd radioactive stent can reduce the expression of BCL-2 gene, promote apoptosis of proliferated smooth muscle cells of bile duct, and suppress stricture (formation) of extrahepatic bile duct.

PURPOSETo investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling.

METHODSTwenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment.

RESULTSCompared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group.

CONCLUSIONExternal ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.

Adult ; Aged ; Brain ; physiopathology ; Brain Edema ; physiopathology ; therapy ; Brain Injuries ; complications ; Cerebrovascular Circulation ; Drainage ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Retrospective Studies

Objective:To understand the reported incidence level, change of the trend, epidemic characteristics and spatial clustering of scrub typhus in Nanjing, to explore key seasons, populations and areas for prevention and control, and to guide formulation of scientific and precise prevention and control strategies and measures.Methods:The reported data of scrub typhus in Nanjing from January 1, 2011 to December 31, 2020 were collected in the "Infectious Disease Surveillance System" from Chinese Center for Disease Control and Prevention. The reported incidence level and change of the trend were analyzed, and the seasonal, population and spatial distribution characteristics were described. Global spatial autocorrelation analysis was carried out by ArcGIS 10.3 software, and the spatial clustering scanning was carried out by using FleXScan 3.1.2 software.Results:A total of 192 cases of scrub typhus were reported in Nanjing from 2011 to 2020. Median annual reported incidence was 0.21/100 000 (0.12/100 000 - 0.49/100 000). Totally 87.5% (168/192) of cases were reported from October to November, and the peak occurred in November (57.8%, 111/192). Among these cases, males accounted for 64.1% (123/192); and the median age was 59 years old (6 - 84 years old). The groups ≥60 years old and 45 - 59 years old accounted for 47.9% (92/192) and 31.2% (60/192), respectively, which accounted for 79.2% (152/192) in all groups. Farmers accounted for 43.8% (84/192), household chores and unemployed people accounted for 16.7% (32/192), retired persons accounted for 15.6% (30/192) and workers accounted for 6.8% (13/192), which accounted for 82.8% (159/192) in all occupations. The top four areas in the total number of reported cases were Jiangning District (23.4%, 45/192), Luhe District (22.9%, 44/192), Gulou District (10.4%, 20/192) and Jiangbei New Area (8.9%, 17/192), which accounted for 65.6% (126/192) in all districts. According to global spatial autocorrelation analysis, Moran's I = 0.34 ( Z = 5.90, P < 0.001). FlexScan 3.1.2 software scanned and detected two spatial clusters areas, the first-class of cluster area covered three streets in Jiangning District, one street in Yuhuatai District and two streets in Pukou District [restricted log likelihood ratio ( RLLR) = 26.91, P < 0.001]. The second-class of cluster area included six townships/streets in Luhe District and four streets in Jiangbei New Area ( RLLR = 26.48, P < 0.001). All the cluster areas were agriculture-related. Conclusions:The reported incidence level of scrub typhus in Nanjing is low and stable which belongs to a typical autumn epidemic area. The middle-aged and elderly population is the key population and the agriculture-related area is key area. It is suggested that scrub typhus should be included in the management of statutory or regional key infectious diseases in Nanjing. Additionally, training on diagnosis and treatment technology and information report management of scrub typhus need to be carried out, and comprehensive prevention and control interventions such as health education, personal protection, rodent prevention and control and vector control should be strengthened and implemented in the high incidence season.

【Objective】 To summarize a rapid and effective method to eliminate autoantibodies interference with blood group identification and evaluate its treatment effect. 【Methods】 Blood samples with suspicious results in initial blood group identification were collected, and those caused by autoantibodies were chosen, and their red blood cells were washed, dispersed or treated with sulfhydryl reagent. After allogeneic or autologous absorption of plasma, blood groups of those patients were re-detected to evaluate the effectiveness of the above method. 【Results】 Among 39 patients presenting suspicious ABO blood group, 9 were interfered by autoantibodies. After appropriate treatment, the ABO/RhD blood group of those patients could be identified. 【Conclusion】 Autoantibodies could interfere the identification of ABO/RhD blood group, and the efficiency and accuracy of blood group identification could be improved by analyzing the test results and selecting appropriate treatment methods.