Objective To summarize the perioperative experience of nursing the middle-aged and elderly patients of lumbar spinal stenosis and degenerative lumbar scoliosis treated with posterior or transforaminal lumbar interbody fusion. Methods Posterior or transforaminal lumbar interbody fusion was performed in 69 middle-aged and elderly patients with lumbar spinal stenosis and degenerative lumbar scoliosis. Nursing measures included evaluation and treatment of complications, preoperative guidance for surgical body position, and postoperative close monitoring, treatment of complications and functional exercises. Results The operation on all the 69 patients was smooth, with surgical time ranged from 3 to 7 hours and bleeding volume between 300~750 mL. Postoperatively, 9 patients suffered from CSF leaks, 3 ones had a screw loose by imageology, 2 did from pneumonia, 2 did from DVT, and 3 did from depression. After clinical management and nursing, all the patients were cured and discharged. Conclusions Meticulous clinical treatment and nursing of preoperative complications and instructions on body position are the foundation for successful surgeries. Postoperatively, close monitoring, management of the complications and the instruction on functional exercises are guarantees for the successful surgeries.

Objective To investigate the detection rate of IAD or IAT and the degree of depression,anxiety and self-conscious-symptoms of IAD or IAT cases in adolescent students,and to analyze the relationship between IA and mental health.Methods 8 694 students from 9 schools in Tianjin by systemic stratified random sampling were investigated on the conditions of internet using and state of psychological and body health with questionnaire designed by ourselves.Result Among the students with internet using,the detection rate of depression was 24.47%.The detection rate of depression in students using internet is 24.47%.IAD,IAT and Non-IA are 32.16%,26.83%,23.17%,respectively.The detection rate of anxiety in students using internet is 3.32%.IAD,IAT and Non-IA are 12.13%,3.72%,2.26% respectively.There was a linear correlation of IA with the degree of depression and anxiety(P

Objective To investigate the infection sites,the offending species,diagnosis and prognosis of deep fungal infections (DFI) in patients with systemic lupus erythcmatosus (SLE).Methods Fifty-one patients with fungal infections in 1466 SLE patients admitted to Peking Union Medical College (PUMC) Hospital from 2000 to 2006 were reviewed retrospectively.Results Candida albicans was ranked the first pathogen,followed by ncoformans and Aspergillus species.The infection sites were lungs,cerebral meninges and blood in the order of prevalence.The overall mortality was 20%(10/51).Aspergillasis carried the highest mortality which couht be as high as 80%.Hypoproteinemia,multiple focus of fungal infections,Aspergillasis and fungemia might he the independent risk factor for mortality.Conclusion Candida albicans is the most frequent species of fungal infections in SLE patients.Iungs are the most prevalent location of infection.Earlier diagnosis is important.Special attention should be paid to aspergillasis.

Objective To evaluate the efficacy and adverse reaction of the first line therapy with rabbit-antithymocyte globulin (ATG) combined with Cyclosporine (CsA) in children with acquired severe aplastic anemia.Methods A retrospective analysis was performed.The clinical data included 44 children with acquired severe aplastic anemia treated with ATG combined with CsA in Beijing Children's Hospital Affiliated to Capital Medical University between June 2006 and December 2013.The SPSS 19.0 statistical package was used for data analysis.Results Sixteen cases were severe aplastic anemia,and 28 cases were very severe aplastic anemia.The median age of treatment with ATG was 8 years old and 10 months.The median follow-up period was 24 months.The hematologic response rate was 66％ (29/44 cases) in 6 months after ATG treatment,and the overall response rate was 77％ (34/44 cases) at the endpoint of follow-up.The median time of partial remission (PR) was 3 months,of complete remission (CR) was 12 months.Eighty-five percent (29/34 cases)effective cases achieved PR during 6 months,while 56％ (15/27 cases)cases achieved CR in 12 months.There was no significant difference between the response rate with ATG treatment and gender,severity of disease,age,interval from clinical onset to ATG treatment,and ratio of CD4 +/CD8 +.The response rate in children without serum sickness was superior to that with serum disease(P =0.006).Thirty-four cases (77％) manifested immediate side-effects with ATG infusion.The side-effects included fever,chill,rash,gastrointestinal distress and irritable cough.The overall 2-year survival rate was 87.3％ (39/44 cases) and the 2-year transplantation-free survival rate was 82.5％ (37/44 cases) (x2 =0.34,P =0.56).Conclusions The response rate with rabbit-ATG combined with CsA in children with acquired severe aplastic anemia was 77％.The adverse reactions were minor.The immunosuppressive therapy should begin as soon as possible in children without chance for hematopoietic stem cell transplantation.

Objective To evaluate the clinical results of femoral-deep femoral crossover bypass in the treatment of long-segment unilateral iliac artery occlusive disease.Methods From July 1995 to December 2010,40 patients (28 males,12 females,aged from 66 to 90,with mean age of 73) with comprehensive unilateral iliac-superficial femoral arteriosclerosis obliterans were enrolled in this procedure.All patients suffered from unilateral common iliac,external iliac,common femoral,and superficial femoral arteriosclerosis obliterans.These patients were treated with femoral-deep femoral crossover bypass.Postoperative ankle-brachial index,blood flow velocity and patency rates in 5,7 and 10 years and limb salvage rates in 5,7 and 10 years were evaluated.Results There was no perioperative mortality nor extremity amputation.35 (87.5％ ) patients were followed-up from 1 to 13 years (mean 5.7 y).Anklebrachial index rose from preoperative 0.23 ± 0.10 to postoperative 0.55 ± 0.11 (t =15.91,P =0.000 ).Popliteal arterial velocity rose from preoperative ( 14 ±6) cm/s to postoperative (34 ± 10) cm/s (t =15.63,P =0.000) ; Tibial arterial velocity rose from ( 10 ±4) cm/s to (22 ±7) cm/s (t =15.71,P =0.000).The primary and secondary patency rates were 60.1％,44.3％,25.3％,and 93.5％,86.8％,57.9％ at 5,7 and 10 years,respectively.Limb salvage rates were 97.5％,95％,and 90％,at 5,7 and 10 years,respectively.Conclusions Femoral-deep femoral crossover bypass is safe and reliable in treating certain unilateral iliofemoral occlusive disease,especially for high-risk old patients or those who are not indicated for endovascular therapies or direct aortic approaches.

Objective:To analyze the clinical characteristics and diagnosis and treatment of children with Kasabach-Merritt phenomenon (KMP).Methods:A retrospective analysis was conducted on the clinical data and follow-up data of 8 patients diagnosed KMP in Beijing Children′s Hospital, Capital Medical University from January 2016 to January 2019.The clinical data included laboratory examination, diagnosis, treatment and prognosis.Results:Among the 8 children with KMP, 6 cases were male and 2 cases were female.The median onset age was 4 (0-17) months, 2 cases of neonatal onset.The median onset to the diagnosis time was 59 (34-140) days; 6 cases with bone destruction; 6 cases had misdiagnosis and mistreatment history, they were misdiagnosed as idiopathic thrombocytopenic purpura, Evans syndrome, abnormal bone and joint development; 4 cases were Kaposiform hemangioendothelioma; 8 cases were used alone or combined with the application of hormones, Sirolimus, and Vincristine, 7 patients underwent interventional therapy.All patients survived with a median follow-up period of 487 (112-1 033) days.Median time of platelet count returned to normal was 24.5 (7-60) days, and median time of fibrinogen returned to normal was 20 (7-30) days.Median time of D-dimer dropped to a normal was 105 (40-240) days.Conclusions:Children with concurrent platelet count and coagulation abnormalities should be considered with KMP.Doctors need to identify the potential visceral vascular lesions.Early diagnosis and treatment are important, which can improve the clinical prognosis of patients.

The clinical and laboratory data of a patient with chronic refractory immune thrombocytopenia (ITP) who had a significant increase in the proportion of inhibitory T cells in the hematological oncology center of Beijing Children′s Hospital Affiliated to Capital Medical University in February 2018 and regularly followed up in the outpatient department received a retrospective analysis.This 8-year-old patient′s clinical features were 6 years of skin and mucous membrane bleeding spots and petechiae recurring, with occasionally nasal epistaxis.Physical examination: cardiopulmonary abdomen and nervous system examinations are normal, and no superficial lymphadenopathy is touched.Blood routine indicated that the platelets were 2.00×10 9/L, and white blood cell count and hemoglobin level were normal.Bone marrow suggested that hyperplasia was significantly active, with more than 300 megakaryocytes.The patient was diagnosed with ITP, and he was treated with first-line treatment with gamma globulin and oral Corticosteroids.The first-line treatment with high-dose Dexamethasone therapy was repeated, and the second-line treatment was low-dose Rituximab combined with high-dose Dexamethasone.Evaluations had been conducted with every relapsed course, and Cyclosporine was administered orally on the basis of the highly suppressive T cells.After half a month, the child achieved partial remission and continued for 3 months, and then reached a complete remission of 6 months (till this paper). It is suggested that, with ITP as an immunological disease with high heterogeneity, the immune abnormality index is expected to become a breakthrough in the development of precise treatment.

Objectiye To optimize the depth of the microchannel and the time point for sperm collection,and improve the efficiency of sperm screening on a microfluidic device. Methods Microchannels with four different depths of 25, 50, 100 and 200 μm were tested. Mice sperm were added to the inlet of the microchannel. The relative quantity and motility of sperm in the outlet were recorded at different collection times, i.e. ,5, 15, 30 and 60 min. Statistical method one-way ANOVA and appropriate post-hoc testing were applied to analyze differences between different groups, and further to select the best-fit depth of the microchannel and the time point for collection. Results In microchannels with depths of 25, 50, 100 and 200 μm, the sperm motilities measured in each outlet were (85.4 ± 2.3)%, (85.8 ± 5.8)%,( 87. 2 ± 2. 8 ) %, (76. 5 ± 2. 8 ) % respectively with statistical significance ( F = 5.8, P ＜ 0. 05 ). No obvious differences were found among 25-100 μm channels, however the motility dramatically decreased in the 200 μm group. The relative sperm quantities were (5.2 ±2.0)%, (7.2 ±2.5)%,(12.3 ±2.0)%,(7. 7 ± 1.1 ) % respectively with statistical significance ( F = 6. 9, P ＜ 0. 05), which increased with channel depth from 25 to 100 μm,while it decreased in the 200 μm channel Taking 2 indexes into account, 100 μmwas the most fit channel depth for sperm motility screening. The sperm motility in the outlet gradually decreased with time. At the time points of 5, 15, 30 and 60 min after adding sperm, the sperm motilities were (99. 6 ±0. 7)%, (87.2 ±2. 8)%, (79. 3 ±2. 2)% and (62. 6 ±8.0)% respectively with statistical significance ( F = 37. 3, P ＜ 0. 01 ). Yet the relative quantities of sperm in the outlet increased almost three times in this process. At the time points mentioned above, the relative quantities of sperm were (5.8±1.1)%, (10.6 ± 0.9)%, (12.1 ± 1.7)%, (17.9 ± 3.4)% respectively with statistical significance ( F = 17.8, P ＜ 0. 01 ). Thus 15-30 min was the ideal screening time. Conclusion An effective microdevice for sperm screening with optimized depth and collection time period is developed,which may contribute significantly for the screening of healthy sperm on microfluidic chips.

PurposeIt is well known hypobaric hypoxia occurs with acute exposure to high altitude, with commonly associated change of cerebral blood flow (CBF). In this work, three-dimensional arterial spin-labeling (3D ASL) was used to monitor the change of CBF to further extend our understanding of hypobaric hypoxia.Materials and Methods Six healthy subjects were recruited for this study, they were asked to stay at high altitude areas for 5 days, and then returned to the plain. All subjects received MRI examination in both plain and high altitude areas using exactly the same 3.0T MR scanner. A total of 8 MR scans were performed, and all the parameters were kept the same, the changes of cerebral blood flow were observed.ResultsCBF increased obviously and reached its peak after acute exposure to high altitude, at the first day at high altitude, CBF measurements in global brain, grey matter and white matter increased signiifcantly compared to the plain, the difference was statistically significant (P<0.05); after that, the CBF measurements started to gradually decrease in the second day and a small climb on the third day at high altitude, then the CBF continued to drop after returning to sea level, even below that at sea level prior to departure. After 1 week back to the plain area, CBF measurements in global brain, grey matter and white matter were still lower than those before departure for high altitude areas, with a statistically signiifcant difference (P<0.05).ConclusionCBF measurements had obvious increase upon initial arrival at high altitude, and then the CBF continued to drop even below that at sea level prior to departure.

Objective To further clarify the pathogenesis of different types of Kaposi′s sarcoma (KS) by measuring the protein expressions of caspase-3 and E-cad in tumor tissues of Xinjiang Uygur patients with acqured immunodeficiency syndrome (AIDS)-Kaposi′s sarcoma (KS) and classical KS.Methods From July 2011 to October 2014, 38 patients with KS at the First Affiliated Hospital of Xinjiang Medical University and Urumqi Infectious Disease Hospital were enrolled, among whom 28 were male and 10 were female, and all of them were uygur.Immunohistochemical and Western blot methods were used to detect the expressions of caspase-3 and E-cad proteins in 22 cases of AIDS-KS patients and 16 cases of classic KS.The quantitative data of normal distribution were analyzed by t test, while count data were compared with χ2 test with R × C table.Results KS lesions in patients with classic KS were confined to the skin, without mucosal, lymph node or visceral involvement.Lesions in AIDS-KS patients were not only confined to the skin and superficial lymph nodes, but also oral mucosa involved in 12 cases and internal organs involved in 7 cases.Liver and lung involvement was more common.The CD4+T lymphocyte count in patients with AIDS-KS was (200.8±166)/μL.All 15 AIDS cases with CD4+ T cell count less than 200/μL developed opportunistic infections.CD4+ T lymphocyte count of patients with classic KS was (562.52±222.66)/μL and the 16 patients with CD4+T lymphocyte count greater than 350/μL had no opportunistic infections.The results of immunohistochemistry showed that the positive expression rate of caspase-3 protein in KS tissues in patients with AIDS-KS was 68.2%, in patients with classic KS was 100.0%, with significant difference between two groups (χ2=7.37, P=0.01).The positive expression rate of E-cad protein in KS tissues in patients with AIDS-KS was 72.7%, in patients with classic KS was 100.0%, with significant difference between two groups (χ2=5.18, P=0.03).Western blotting showed that the gray value of caspase-3 in the KS tissue of patients with AIDS-KS was 0.55±0.36, and that in patients with classic KS was 0.86±0.56, with significant difference between two groups (t=-2.070, P<0.05).The gray value of E-cad in the KS tissue of patients with AIDS-KS was 0.54±0.41, and that in patients with classic KS was 0.85±0.45, with significant difference between two groups (t=-2.060,P<0.05).Conclusions There are differences in the protein expressions of caspase-3 and E-cad in tumor tissues of patients with AIDS-KS and classical KS in Xinjiang Uygur patients with Kaposi's sarcoma, which may correlate with a faster progression and a higher mortality rate for AIDS-KS.