Objective To investigate the relationship of change in hemodynamics of portal system and liver reserve of Chile-Pugh classification in patients with hepatocirrhosis.Methods Color Doppler ultrasound were applied to detect the inner diameter,average velocity of blood flow,quantity of blood flow of portal vein and splenic vein for 173 patients with post-hepatitis hepatocirrhosis(61 of Child grade A,53 of grade B,59 of grade C),which were sub- sequently compared with the healthy controls.Results In patients with hepatocirrhosis,the inner diameter of portal vein and splenic vein were widened,the average velocity of blood flow of portal vein and splenic vein were slowed down and the quantity of blood flow of splenic vein was increased,and the worse the damage of liver function was, the more obvious the change became.Conclusion The change in hemodynamics of portal system varies with the damage in liver function in patients with hepatocirrhosis.Measuring the hemodynamics of portal system is significant in determining the severity of the disease and the prognosis.

AIM:To compare the efficiency of fibrin glue to suture technique in pterygium surgery performed with limbal autograft under different methods of anesthesia.
METHODS: A prospective randomised clinical trial was carried out in 60 eyes of 55 patients operated for primary nasal pterygium, which were divided into two groups randomly: experimental group ( 30 eyes in 27 patients ) was under surface anesthesia ( oxybuprocaine ) and control group ( 30 eyes in 28 patients ) was under local anesthesia ( 20g/L lidocaine ). Autologous limbal graft taken from the superotemporal limbus was used to cover the sclera by a fibrin tissue adhesive after pterygium excision. Patients were followed up at least for 6mo. Time of operation, matching degree of graft and VAS score were mainly observed and recorded.
RESULTS: In experimental group the average surgery time was shorter (P=0. 008) and matching degree of graft ( 93%) was better than control group ( 83%) , the differences had statistical significance(P<0.05).
CONCLUSION: The surface anesthesia is enough when using fibrin glue for graft fixation in pterygium surgery, which will shorten surgery time and get better matching degree of graft.

Objective To investigate the bone marrow morphology characteristics in patients with severe fever with thrombocytopenia syndrome (SFTS)and to evaluate the clinical value of bone marrow morphology examination in the diagnosis of SFTS.Methods The bone marrow morphology and clinical data of six newly diagnosed SFTS patients with positive test of novel bunyavirus infection admitted to Taizhou Hospital from July 2011 to November 2014 were retrospectively analyzed.Results The increased ratio of lymphoid and monocytoid histiocytes (0.02 - 0.23 )and hemophagocytic phenomenon were observed in all of the six patients′ bone marrow smears.Two of the six cases were diagnosed with hemophagocytic lymphohistiocytosis (HLH)according to the clinical diagnosis criteria and the remaining four cases were defined as highly suspected HLH.Conclusions The progression of SFTS disease might be closely related with HLH induced by novel bunyavirus infection.Morphology examination of bone marrow smear is beneficial for the early differential diagnosis of SFTS.

Objectives To investigate the role of lymphangiogenesis in the perineural micrometastasis of pancreatic adenocarcinoma. Methods The clinical data of 30 pancreatic adenocarcinoma patients who were admitted from Sep. 2005 to Oct. 2006 for extended radical surgery were collected. The samples including pancreatic cancer, adjacent tissue, lower bile duct, pancreatic tail, the structure surrounding the SMA (peripancreatic nerve plexus) and lymph nodes were collected during operation. They were subjected to conventional pathological examination. The lymphatic capillaries weredetected by double immunohistochemical staining and the lymphatic vessel density ( LVD) was measured. Results Intra-pancreatic and/or peripancreatic neural invasion was observed in 25 patients (83. 3% ) , of which 20 were found to have both the peri-pancreatic and intra-pancreatic neural invasion. The other 5 only had the intrapancreatic neural fiber invasion and there was no single patient with peri-pancreatic neural fiber invasion only. Peri-neural invasion was not significantly associated with patients' age, gender, lymph node metastasis, tumor size and the location (P > 0.05) , but was obviously associated with JPS clinical staging ( P < 0. 05 ). The mean intratumoral LVD was (4.2 ±3.4) per field, which was significantly lower than (11.3 ±6.9) per field of adjacent tissue and (10.8 ±4.4)per field of normal pancreatic tissue(P<0.01). The mean intratumoral LVD between adjacent tissue and normal pancreatic tissue was not statistically different. Lymphatic vessel invasion was observed in non-malignant tissues in 18 patients, and there was a distribution correlation between lymphatic vessel invasion and extra-pancreatic neural plexus invasion (P<0.05). Conclusions The incidence of peri-neural invasion was high, peri-neural invasion was associated with JPS clinical staging and lymphatic vessel invasion, which suggested the possibility of the cancer spreading by peritumoral lymphangiogenesis route into the peri-SMA neural plexuses.

Objective To study the effects of different level of iodine nutrition on the thyroid function in women of reproductive age. Methods A total of 100 (50 from each) women of reproductive age but not pregnant were collected from iodine deficient and adequate areas. The questionnaire was obtained individually with items concerning personal history of thyroid diseases, goiters and category of edible salt and drinking water based on the project design. The household salt and drinking water were collected for measuring iodine content, and blood samples were obtained for TSH, FT4 and FT3 testing. Results The coverage of iodized salt and the median level of urinary iodine in iodine deficient women(72.0% and 95.5 μg/L) were obviously lower than that in iodine sufficient women(100.0% and 167.4 μg/L, χ2=16.28, U = 632.00, P < 0.01). Median level of serum TSH in iodine deficient women (2.56 m U/L) appeared in an increasing tendency compared to the iodine sufficient women (1.88 mU/L), but there was no significance (U=990.50, P > 0.05). Serum FT4 mean level in iodine deficient women [(14.7±2.0) pmol/L]was lower than that in iodine sufficient women[(17.0±3.8)pmoI/L, t=3.76, P<0.01]. There was no difference in serum FT3 between two group women[(5.1±1.4), (4.8±0.5)pmoI/L, t = 1.59, P > 0.05]; but FT3/FT4 ratio in iodine deficient women(0.33±0.04) was markedly higher than that in the iodine sufficient women(0.30±0.04, t=3.13, P<0.01). The percentage of thyroid dysfunction in iodine deficient women[20.0% (10/50)]was higher compared with the iodine sufficient women[8.0%(4/50)], but without significance(χ2=2.99, P>0.05). Conclusions Iodine deficiency is a primary cause leading to hypothyroid in women of reproductive age. Long term of iodized salt usage is an efficient way to correct iodine deficiency.

Abstract: Objective　To analyze the epidemiological characteristics of 151 cases of melioidosis and the drug resistance of Burkholderia pseudomallei (BP), in order to provide the basis for diagnosis, treatment and reasonable prevention of melioidosis. Methods　A total of 151 inpatients and outpatients from the Second Affiliated Hospital of Hainan Medical University from January 1, 2013 to August 31, 2022 were collected, and clinical specimens were submitted for examination to isolate and identify BP strains. The clinical data of 151cases of melioidosis and the drug resistance characteristics of pathogenic bacteria were retrospectively analyzed, and using SPSS26.0 software for statistical analysis. Results　Among 151 cases with BP infection, there were 138 males (91.4%) and 13 females (8.6%); the most patients were aged from 45-<60 years old, accounting for 74 cases (49.0%); melioidosis incidence was concentrated in October (19.2%), November (19.2%), August (9.9%) and July (8.6%), and; the number of confirmed cases showed an increasing trend and the time for confirmation was <10 d; Internal medicine system (31.1%), surgery system (26.5%) and intensive care department (20.5%) were the common departments for treating melioidosis; blood (49.0%), sputum (9.9%) and wound secretion (8.6%) were the main clinical specimens for detecting BP; pulmonary infection (68.2%), sepsis (35.1%) and local suppurative infection (23.8%) were the top clinical manifestations in patients with BP infection; the effective rate of treating melioidosis was 74.8%; abnormal liver function was a risk factor for the curative effect of melioidosis (χ2=5.010, P<0.05); the sensitivity rates of BP strains to sulfamethoxazole-trimethoprim (SXT), doxycycline (DOX), imipenem(IPM), ceftazidime (CAZ), amoxicillin/clavulanate (AMC) and tetracycline (TCY) were generally more than 90%, with sensitivities of 98.7%, 97.2%, 96.7%, 94.0%, 93.2% and 90.7%, respectively. Conclusions　It can be concluded that misdiagnosis or missed diagnosis of melioidosis is easy to occur, and the understanding of the epidemiological characteristics and risk factors in this area should be strengthened. The sensitivity of BP to commonly used antibiotics has shown a certain downward trend, clinical use should be standardized, and drug resistance monitoring should be strengthened to improve the efficacy of melioidosis treatment.

OBJECTIVETo compare the incidence of metabolic disorders (MS) in patients with primary aldosteronism (PA) and essential hypertension (EH).

METHODSMS prevalence was observed in 200 EH patients (male 104) and 220 PA patients (male 117) hospitalized to our hospital from August 2005 to March 2007.

RESULTS(1) The prevalence of MS in PA group was significantly higher than that of EH group (47.3% vs. 31.5%, P = 0.009). (2) Blood pressure was significantly higher in PA group than that of EH [SBP: (150.67 +/- 15.45) mm Hg vs. (145.69 +/- 17.13) mm Hg, P = 0.042; DBP: (93.03 +/- 10.51) mm Hg vs. (85.83 +/- 14.44) mm Hg, P = 0.037]. (3) Incidences of abdominal obesity (86.8% vs. 78.5%, P = 0.024) and insulin resistance (insulin sensitivity index: 42.42 +/- 16.11 vs. 49.58 +/- 22.43, P = 0.008) were significantly higher in PA group than in EH group.

CONCLUSIONThe prevalence of MS in hospitalized PA patients was significantly higher than that of EH patients characterized by prevalent abdominal obesity, insulin resistant and severe hypertension.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Hyperaldosteronism ; epidemiology ; metabolism ; Hypertension ; epidemiology ; metabolism ; Incidence ; Male ; Metabolic Syndrome ; epidemiology ; Middle Aged

OBJECTIVETo investigate the efficacy of oral sweet solutions in relieving pain caused by vaccination in infants aged 1 to 12 months.

METHODSRelated databases were searched to find related randomized control trails (RCTs). The quality of these RCTs was evaluated. The Meta analysis was performed using RevMan 5.3.

RESULTSA total of 20 RCTs involving 2 376 infants were included, and quality assessment showed that 6 RCTs had grade A quality and 14 had grade B quality. The Meta analysis showed that compared with sterile water, 25%-75% oral sweet solution significantly reduced crying time (WMD=-21.16, 95%CI -39.66 to -2.77, P<0.05) and the proportion of crying time (the duration of crying /3-minute periods after the injection) (WMD=-13.83, 95%CI -20.88 to -6.78, P<0.01), while the crying time showed no significant difference between the group treated with oral administration of 12% sucrose solution and non-intervention group. Co

ONCLUSIONSOral sweet solution (25%-75%; 2 mL) given 2 minutes before vaccination can effectively relieve the pain caused by vaccination in infants aged 1-12 months.

Crying ; Humans ; Infant ; Pain ; prevention & control ; Solutions ; Sucrose ; administration & dosage ; Vaccination ; adverse effects

Objective To analyze the relationship between the catheter to vein ratio and the formation of peripheral insertion of central venous catheter (PICC) related upper extremity deep venous thrombosis (PICC-UEDVT) in cases having undergone PICC in patients at intensive care unit (ICU) and further identify the best optimal ratio cut-off point to reduce the incidence of PICC-UEDVT.Methods A retrospective study was conducted, including 69 patients having undergone PICC with complete clinical data admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Nanchang University from August 2013 to December 2016; their ages were > 18 years old and catheter indwelling times were > 1 week; the patients' basic information, disease related laboratory parameters and catheter insertion situation were collected. According to the occurrence of PICC-UEDVT, they were divided into PICC-UEDVT group and non PICC-UEDVT group; the receiver operating characteristic (ROC) curve of the catheter to vein ratio versus the incidence ofPICC-UEDVT was plotted to assess the optimal ratio to reduce the incidence of PICC-UEDVT.Results In the 69 patients, there were 7 patients in the PICC-UEDVT group and 62 patients in the non PICC-UEDVT group, the incidence of PICC-UEDVT being 10.14%. Four, 5 and 6 French (Fr) catheters were indwelled in 43, 23 and 3 cases respectively, and the range of catheter to vein ratio was 20% - 67%. The comparisons between PICC-UEDVT group and non PICC-UEDVT group in various aspects were as follows: the incidence of DVT in the PICC-UEDVT group was significantly higher than that in non PICC-UEDVT group [42.9% (3/7) vs. 6.5% (4/62)], the rate of using vasopressor drugs [57.14% (4/7) vs. 17.74% (11/62)], D-dimer level [mg/L: 9.0 (3.0, 12.3) vs. 1.8 (1.0, 3.6)], patients of indwelling 5Fr catheter [71.4% (5/7) vs. 29.0% (18/62)] and the percentage of patientsapplying catheter to vein ratio 45%-67% [57.14% (4/7) vs. 17.74% (11/62)] in PICC-UEDVT group were all higher than those in the non PICC-UEDVT group, the differences being statistically significant (allP < 0.05). ROC analysis showed that the catheter to vein ratio 44% was the optimal cut off or critical point, the area under the ROC curve (AUC) at that point was 0.755, 95% confidence interval (95%CI) = 0.554-0.955, sensitivity = 71.4% and specificity = 79.0%; compared with the patients using 45%-67% catheter to vein ratio, the incidence of PICC-UEDVT was 6.182 times higher than those using the ratio 20%-44% [odds ratio (OR) = 6.182, 95%CI = 1.208-31.634,P = 0.036]; however, there was no significant difference in incidence of PICC-UEDVT between 20%-32% and 33%-44% (P = 1.000).Conclusion It is found that the 44% catheter to vein ratio was the optimal critical point to reduce the incidence of PICC-UEDVT, possessing relatively high sensitivity and specificity; applying <44% catheter to vein ratio can decrease the risk of PICC-UEDVT occurrence in patients at ICU.

Objective To explore the clinical application of percutaneous endoscopic gastrostomy in gastroin- testinal nutrition among critically ill patients.Methods Twenty-two patients were undertaken percutaneous endo- scopic gastrostomy under the lead of gastroscope.The puncturatio site was located in anterior wall of stomach.Results All the procedures were performed successfully for one time.Intraoperational blood pressure was very steady.At the same time,intraoperational SpO_2 of the patients all exceeced 97%.The bleeding amount and operation time were respectively (3.8?1.9) ml and (15.5?2.3) min.Severe complications such as gastrostoma,gastrocolic fistula, pneumoperitoneum,refluxing or aspiration of gastric juice,inhalant pneumonia didn't occur after the operation.Con- clusion Percutaneous endoscopic gastrostomy was safe and feasible among critically ill patients who needed gastroin- testinal nutrition because of its slight injury,little bleeding and shorter operational time.