Objective　To study the diagnosis, treatment and prognosis of hepatolithiasis combined with cholangiocarcinoma. Methods　The clinical, pathological and follow-up data of 17 cases of hepatolithiasis combined with cholangiocarcinoma were retrospectively analysed. Results　The results showed that the incidence of cholangiocarcinoma in hepatolithiasis was 5% in this series. 17.6% of the patients were diagnosed as cholangiocarcinoma preoperatively. Tumor occurring in intrahepatic ducts was 88.2% and in hepatic porta ducts 11.8%. Nine cases were well-differentiated adenocarcinomas. Only 7(41.2%) cases were radically resected and their average survival time was 26.0 months. Eight(47.1%) patients underwent internal drainage with average survival time 12.4 months. 2(11.7%) cases subject to external drainage with survival time 3.6 months. Conclusions　If patients with hepatolithiasis have a long history of recurrent cholangitis, weight-loss in a short period, progressive jaundice or intractable abdominal pain, the possiblility of combined with cholangiocarcinoma should be considered. Resection of the tumor has a better prognosis than that of tumor unresected; and the prognosis of internal drainage is better than that of external drainage.

With more and more non-affiliated hospitals of universities joining the clinical teaching of infectious diseases,there have been some dilemmas on clinical teaching,such as the shortage of staff,teaching experience,poor lecture art and teaching enthusiasm,textbook lag,the shortage of case teaching abd students'fear of infectious disease etc. Countermeasures such as perfecting the organizational structure,formulating preferential policy,clearing historical mission,increasing students' interest in learning,adding new academic progress,enriching teaching methods,setting up experts'supervision will ensure the effective teaching quality.

Objective To review the experience in managing severe major jugular vascular injuries. Methods Fifteen cases (11 men and 4 women, aged 18～49 years) treated by operation were collected. The injuried vessels included common carotid artery, internal carotid artery, subclavian artery and accompanying veins, carotid reconstruction was performed by jugular vein transplantation and followed by wrapping with PTFE artificial blood vessel in 15 cases. Result All the fifteen patients were cured and the vasculars were well-functioning 3～12 weeks after the surgery. Conclusion The mortality of severe large cervical vascular injuries is very high because of acute bleeding, cerebral ischimia and suffocation. In managing this catastrophe, keeping the airway clear and stop bleeding effectively are fundamental. Good knowledge and expertise in vascular and microvascular surgery are mandatory for the success of the procedure.

OBJECTIVETo investigate the short-course and efficient way to treat mumps meningitis.

METHODSTotally 155 cases of mumps meningitis treated by intrathecal injection with dexamethasone only once were enrolled as experimental group and 55 similar cases treated with the common therapy as control.

RESULTSThe time for recoveries of temperature, headache, the pathologic reflexes and the total time of treatment were 32 hours, 15 hours, 12 hours and 3.1 days, respectively, while those of the control group were 58 hours, 24 hours, 32 hours, 6.5 days respectively. There was statistical difference between the two groups (P<0.01 or 0.05).

CONCLUSIONSIntrathecal injection with dexamethasone only once is efficient and safe in the treatment of mumps meningitis.

Anti-Inflammatory Agents ; therapeutic use ; Child ; Child, Preschool ; Dexamethasone ; therapeutic use ; Female ; Humans ; Infant ; Injections, Spinal ; Male ; Meningitis, Viral ; complications ; drug therapy ; Mumps ; complications ; drug therapy ; Treatment Outcome

Objective:To build a three-dimensional evaluation model of single bed efficiency in an obstetrics and gynecology hospital and provide reference for bed management in hospital.Methods:The sample ward and key indicators were determined through interviews. A two-level database was built according to patients′ data from hospital information system. K-means cluster analysis was used to get the beds classified by annual average vacancy(x), annual average turnover(y) and annual average case-mix index per capita(z). The authors built the three-dimensional bed efficiency model with x, y, z as boundaries and analyzed the bed efficiency by comparing the within group average point A k( x k, y k, z k) with the overall average point A0( x, y, z). Whereafter the bed efficiency of each medical work team was analyzed. Results:Thirty-six beds were classified into 4 categories according to utilization efficiency. 50% of the beds(18 beds) were well used, 28%(10 beds) had room for improvement, and 19%(7 beds) may have resource waste. Significant differences existed in bed efficiency among medical work teams.Conclusions:The model in our study can realize in-depth exploration by evaluating bed efficiency from two aspects of the whole ward and each medical work team. This model, which is mainly applicable to the situation where beds are under the charge of fixed medical work groups or doctors, can be adjusted and extended to meet different strategic needs of hospitals.

Objective To investigate the efficacy of leflunomide combined with prednisone in the induction therapy of proliferative lupus nephritis (LN).Methods A prospective,multicenter,randomized controlled clinical trial was conducted in patients with biopsy-proved proliferative lupus nephritis recruited from 15 renal centers from 2013 to 2015.Patients were randomized to two groups.Oral leflunomide or intravenous cyclophosphamide was given to patients in each group.Both groups received a tapering course of oral prednisone therapy.All patients were followed up for 24 weeks.The blood biochemistry,urine index,clinical curative effect and adverse reaction were recorded and analyzed statistically.Results A total of 100 patients were enrolled in this clinical trial,including 48 patients in leflunomide group and 52 patients in cyclophosphamide group.After 24 weeks,the overall response rate was 79％ (95％ CI 67％-90％) in the leflunomide group and 69％ (95％ CI 56％-82％) in the cyclophosphamide group.23％ (95％CI 11％-35％) of patients in leflunomide group showed complete remission compared with 27％ (95％CI 24％-30％) in cyclophosphamide group (P=0.35).The levels of 24-hr urine protein excretion,SLEDAI and anti-dsDNA antibody titers were decreased in patients treated with leflunomide group after 24-weeks treatment.And the levels of serum albumin and complement 3 after treatment were significantly higher compared with these before treatment.There was also no significant difference in changes of 24-hr urine protein excretion,SLEDAI score,anti-dsDNA antibody titers,serum albumin and complement C3 levels after treatment between two groups.Incidence of adverse events did not differ between the leflunomide and cyclophosphamide group.Conclusions Leflunomide combined with prednisone showed same efficacy compared with cyclophosphamide as induction therapy for lupus nephritis.Leflunomide might be an useful medicine in the induction therapy of lupus nephritis.

Objective:To investigate and analyze the epidemiological and clinical characteristics of 46 patients with corona virus disease 2019 (COVID-19) in Beijing City.Methods:A retrospective study was conducted to analyze the data of 46 patients with COVID-19 in Beijing from 20th January 2020 to 8th February 2020 at the Fifth Medical Center of the PLA General Hospital in Beijing City. Twelve, 23 and 11 patients were assigned to the mild group, common group and severe group, respectively. The epidemiological history, clinical characteristics, laboratory tests and imaging inspections were analyzed. Statistical analysis used Fisher exact test. If P<0.05, post- hoc test was used for pairwise comparison, and the statistics were corrected by Bonferroni test. Results:Among the 46 patients included in this study, 27 were male and 19 were female. The age range was between 3-79 years old, and the age was (41.8±16.3) years old. The average incubation period was (4.85±3.00) days. A total of 26 cases (56.5%) were clustered patients, and 26 cases had a history of staying in Wuhan, 10 cases had contact with Wuhan personnel. Fever (39 cases, 84.8%), cough (27 cases, 58.7%), and fatigue (25 cases, 54.3%) were the main clinical symptoms for these patients. The decrease in white blood cell counts occurred in 12 patients, four had the decrease in T lymphocyte percentage, 17 had the decrease in CD4 + T lymphocyte counts, seven had the decrease in CD8 + T lymphocyte counts, 21 had the increase level of C reactive protein (45.7%), and interleukin-6 (IL-6) level increased in 32 cases (69.6%), erythrocyte sedimentation rate (ESR) increased in 23 cases (50.0%), serum ferritin level increased in 26 cases (56.5%), and blood lactic acid level increased in nine cases. There were statistically significant differences in the proportion of cases with decreased absolute value of CD8 + T lymphocytes and T lymphocytes counts among the mild, common and severe groups (all P<0.05). Comparing the proportion of cases in the three groups with elevated C reactive protein, IL-6, ESR, serum ferritin and blood lactic acid levels, the differences were statistically significant (all P<0.05). The proportion of cases with elevated C reactive protein levels in severe group was higher than those in mild and common groups. The proportion of cases with elevated IL-6, ESR, and serum ferritin levels in severe and common group were higher than those in mild group. The proportion of cases with elevated blood lactic acid levels in severe group was higher than those in mild group. The differences between the above groups were statistically significant (all adjusted P<0.017). Analysis of chest X-rays results showed that 34 patients (73.9%) had inflammation in the lungs. Conclusions:The epidemiological characteristics of patients with COVID-19 in Beijing City are mainly imported cases and clustered cases. The clinical manifestations are mainly fever, fatigue and cough. C reactive protein, IL-6, ESR, serum ferritin and blood lactic acid levels are higher in severe patients.

新冠病毒感染疫情严重威胁着世界各国人民的生命健康。目前，对病毒感染的防治研究主要集中在抑制病毒与分子受体的结合上。AXL作为新发现的严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）受体，在协助病毒感染人体呼吸系统中发挥着重要作用，是未来临床干预的潜在靶点。本研究对已发表的单细胞测序数据进行整理和分析，发现AXL在年轻人肺细胞中的表达水平明显高于老年人。人胚肺二倍体成纤维细胞（2BS）是衰老研究的公认细胞株。本文采用2BS细胞构建复制性细胞衰老模型，发现年轻细胞中AXL的蛋白水平明显高于衰老细胞，据此推测年轻人感染的风险可能更高，需要注意防护。我们发现一种羊栖菜褐藻多糖硫酸酯组分（SFW-3）可显著下调年轻2BS细胞中AXL的表达水平，表明SFW-3具有一定的抗SARS-CoV-2感染的研究价值，同时表明2BS细胞株也可作为潜在的SARS-CoV-2体外感染模型。
Humans ; SARS-CoV-2 ; Sargassum/metabolism* ; Diploidy ; Sulfates/metabolism* ; COVID-19 ; Polysaccharides/pharmacology* ; Lung