Objective To explore the feasibility and t he efficacy of laparoscopic splenectomy of massive splenomegaly in the treatment o f hereditary spherocytosis in children. Methods Seven children with massive splenomegaly underwent laparoscopic splenectomy. Their age ranged 1~14 years (mean, 8.8 years), and their body weight was 10~57 kg (mean, 33.8 kg) . Three children had an accompanying cholelithiasis: 2 of them received a concom itant cholecystectomy and 1 of them, cholecystotomy. Results A ll the operations were successfully performed under laparoscope, and hand-assist ed splenectomy through a small incision was applied in 1 child because of bleedi ng of the splenic vein. The duration of operation was 50~150 min (mean, 90 min), the intraoperative blood loss was 30~500 ml (mean, 117 ml), and the length of h ospitalization, 4~10 d (mean, 5.5 d). The red blood cell counts had significantl y increased 3 days following the operation (t=2.652, P

Objective:To explore the effect of bifidobacterium tetravaccine tablets combined with low-dose erythromycin on the efficacy and motilin (MTL) levels in the treatment of children with functional dyspepsia (FD).Methods:One hundred and fifty children with FD admitted to Shanghai Public Health Clinical Center from January 2019 to June 2020 were selected and were divided into two groups by random number table, with 75 cases in each group. The control group was treated with bifidobacterium tetravaccine tablets, and the observation group was treated with low-dose erythromycin on the basis of control group. The clinical efficacy and the disappearance time of the clinical symptoms of the two groups were compared. The changes in the frequency of gastric antrum contraction (ACF), the amplitude of gastric antrum contraction (ACA), the gastric antral movement index (MI) were detected by ultrasonic developing-out unit before and after treatment. The levels of 5-hydroxytryptamine (5-HT), nitric oxide (NO), gastrin (GAS) and MTL were detected before and after the treatment using enzyme linked immunosorbent assay. The incidence of adverse reactions was counted. The recurrence rate was recorded after 6 months of the treatment.Results:The total effective rate in the observation group was higher than that in the control group:93.33% (70/75) vs. 78.67% (59/75), and the difference was statistically significant ( χ2 = 6.700, P<0.05). The disappearance time of symptoms of nausea and vomiting, loss of appetite, abdominal distension, and abdominal pain in the observation group were shorter than those in the control group: (2.58 ± 0.45) d vs. (3.22 ± 0.68) d, (3.56 ± 0.62) d vs. (4.10 ± 0.70) d, (2.54 ± 0.46) d vs. (3.24 ± 0.69) d, (2.66 ± 0.56) d vs. (3.40 ± 0.67) d, and the differences were statistically significant ( P<0.05). The levels of ACF, ACA and MI in the observation group after the treatment were higher than those in the control group: (4.32 ± 0.90) times/min vs. (3.58 ± 0.83) times/min, (0.34 ± 0.12) vs. (0.30 ± 0.10) mm, (1.33 ± 0.42) vs. (1.14 ± 0.30), and the differences were statistically significant ( P<0.05). The levels of 5-HT and NO in the observation group after the treatment were lower than those in the control group: (164.77 ± 30.34) mg/L vs. (184.45 ± 28.90) mg/L, (38.27 ± 10.20) mmol/L vs. (46.54 ± 9.48) mmol/L; and the levels of GAS and MTL were higher than those in the control group: (115.23 ± 15.70) ng/L vs. (98.50 ± 14.29) ng/L, (266.67 ± 32.76) ng/L vs. (238.40 ± 28.97) ng/L, and the differences were statistically significant ( P<0.05). Conclusions:The treatment of pediatric FD with bifidobacterium tetravaccine tablets combined with low-dose erythromycin can significantly improve the efficacy, quickly improve the clinical symptoms of children, promote physical recovery, and regulate MTL levels to improve gastric motility. The recurrence rate is low.

OBJECTIVE To prevent and control the incidence of nosocomial infection,and improve the inner quality of nosocomial infection management.METHODS A total of 49 363 cases of inpatients in the recent four years were retrospectively analyzed.RESULTS Of them 2 409 cases were infected,the incidence was 4.88%.The lower(respiratory) tract ranked the first place (34.16%) and the highest infected rate was in medicine(department)((8.29%).) Totally 505 isolates of bacteria were found,of which Gram-negative ones accounted for 45.15%,(Gram-)positives 25.15%,fungi were for 29.70%.CONCLUSIONS The incidence of nosocomial infection is(connected) with following factors such as age,inpatient factor,invasive diagnosis and treatment manipulation,the misusage of(antibiotics),and the environment quality.

Objective To investigate the expressions of cell phenotypes CD_8 and CD_(28) of peripheral blood lymphocytes in patients with colorectal cancer. Method CD_8 and CD_(28) of cell phenotypes were measured by flow cytometry in 50 patients with colorectal cancer (cancer group) and 30 nontumorous patients (control group). Results The expression of CD_8 in cancer group was significantly higher than that in control group [(32.24±8.38)% vs (22.18±7.55)%](P < 0.01). CD_(28) and CD_8~+/CD_(28)~+ were much lower than those in control group [(52.03±10.94)% vs (60.60±7.98)%,12.18±4.28 vs 16.38±4.94](P<0.01). CD_8~+/CD_(28)~+ in Dukes D stage patients were significantly lower than that in Dukes B stage patients (P<0.05). CD_(28) and CD_8~+/CD_(28)~+ in lymph node metastasis patients were much lower than those in lymph node negative patients (P < 0.01). CD_(28) and CD_8~+/CD_(28)~+ in serosa involved patients were lower than those in no serosa involved patients (P < 0.01). Conclusions The expressions of cell phenotypes CD_8 and CD_(28) of peripheral blood lymphocytes in patients with colorectal cancer are closely related to biological characteristics of the tumor. The assays of cell phenotypes CD_8 and CD_(28) might be useful for evaluating the immunal statement and prognosis of patients with colorectal cancer.

Objective To study and establish a high quality digital 3D anatomical modeling of the mandible with full teeth.Methods A set of accurate digital models of standard anatomical specimens of mandibular teeth were obtained by laser scanning, and the 3D mandible model was reconstructed by CT scan data;then, a registration deformation method based on the geometry and image anatomical landmark was employed to do the registration of each tooth to the mandible model, and finally the tooth enamel , dentin, periodontal ligament were generated .Results A high quality digital 3D anatomical modeling of the mandible with full teeth was built , each tooth had detail crown and whole root , the distinction between the enamel , dentin, periodontal ligament , and any anatomical regions can be zoomed and rotately displayed . Conclusion The digital 3D anatomical modeling of the mandible with full teeth has realistic 3D imaging view and convenient teaching-learning function , and has tremendous apllication futures in the stomatology , maxillofacial and other medical departments .

Objective To investigate the correlation between coronary lesions with serum cystatin C (Cys C)and vascular endothelial function(RHI)in the patients with coronary heart disease(CHD).Methods A total of 318 patients receiving coronary angiography(CAG)were selected as the research subjects and divided into the control group(65 cases)and CHD group;then the CHD group was divided into the single-vessel lesion group(77cases),double-vessel lesions group(70c ases),multiple-vessel lesions group(106 cases)according to CAG and the number of disease vessels;the CHD group was re-divided into the low score group(67 cases),middle score group(107 cases)and high score group(79 cases)according to the Gensini score of coronary artery lesions.The vascular endothelial function was evaluated by using peripheral arterial tension (PAT)measurement technique.The reactive hypere-mia index(RHI)was calculated;serum Cys C level was determined by immunoturbidimetry.Results The serum Cys C level was in-creased and RHI level was reduced as the number of lesion vessels increasing,the inter-group comparison showed the statistical difference (P <0.05);RHI had no statistical difference between the double-vessel lesions group and multiple-vessel lesions group (P >0.05);the serum Cys C level was increased as the Gensini score increasing,the difference between the groups had statistical significance (P <0.05);the vascular RHI value was reduced as the coronary Gensini score increasing(P <0.05);moreover the Cys C level was positively correlated with the Gensini score (r=0.375,P <0.01);RHI was negatively correlated with corornary Gensi-ni score (r=-0.587,P <0.01 );the serum Cys C was negatively correlated with RHI(r =-0.350,P <0.01 ).Conclusion The vascular endothelial dysfunction and serum Cysc C level increase are associated with coronary lesions in CAD patients,moreover Cys C is negatively correlated with vascular RHI,serum Cys increase may be a predictive index for vascular endothelial function damage in CHD patients.

Objective To study the general shape of anterior cruciate ligament (ACL) insertion in rabbits and establish an animal model of ACL reconstruction using oval tunnels.Methods Eighteen mature white New Zealand rabbits were used in this study.Eight of them were used for anatomy study and the other 10 were for building an animal model.After removal of the medial femoral condyle and other soft tissues around ACL,the morphology of the ACL insertion was examined and the diameter of ACL insertions was measured using a caliper.An oval-tunnel dilator (1.6 mm×2.5 mm) was designed to make an oval-tunnel in the right knee of the rabbits while a round tunnel was drilled using a 2 mm diameter Kirschner wire in the left knee of the rabbits.Their hamstring tendon grafts were harvested as grafts for both sides and the compatibility between the bone tunnel and graft was examined for both groups.Right after the surgery,the knees of both sides were given the three-dimensional CT scan.Results The shape of ACL insertion of rabbits was oval.In the femur side,the average major and minor diameter of the ACL insertion was 5.28 ± 0.83 mm and 2.61 ± 0.33 mm respectively.In the tibial side,the major and the minor diameter of the ACL insertion was 5.33 ± 0.40 mm and 2.68 ±0.11 mm.The bone tunnel was compatible with the graft in both groups.In the oval tunnel ACL reconstruction group,the cross sectional area of the femoral bone tunnel was 3.18 ± 0.09 mm2 and the cross sectional area of the tibial bone tunnel was 3.26 ± 0.15 mm2.In the round tunnel ACL reconstruction group,the corresponding measurements were 3.13 ± 0.10 mm2 and 3.11 ± 0.11 mm2 respectively.There was no significant difference between the two groups.Conclusion The shape of ACL insertion in rabbits is oval.Using the self-made oval tunnel dilator we have successfully built an oval tunnel ACL reconstruction animal model with a good compatibility between the bone tunnel and graft.This lays the foundation for further research in the future.

Objective To investigate long-term data of dry eye after LASIK in young myopia patients.Methods Young myopia patients were divided into treated group (group A) and control (group B),who were interviewed before surgery and on 1 year,3 years and 5 years after surgery.Their diopters,uncorrected visual acuity (UCVA),tear breakup time test,Schirmer I test and corneal fluorescent staining were taken,then dry eye was diagnosed and OSDI questionnaire were scored.Results The postoperative incidence of dry eye in group A was higher than that before surgery (35.6％) and decreased with time (51.7％,44.9％ and 40.7％,respectively),and there was no significant difference in group B at each time point (P ＞ 0.05).The preoperative incidence of dry eye was equal between two groups (P ＞ 0.05),which were much higher in group A after surgery (all P ＜ 0.05).In group A,the postoperative constituent ratio of mild dry eye was the majority and decreased with time (65.6％,52.8％,41.7％,respectively),while moderate and severe dry eye was increased,especially the latter (6.6％,11.3％ and 16.7％,respectively;P ＜ 0.05).At 5 years after surgery,the UCVA and visual function score in dry eye patients were lower than those of non-dry eye patients (all P ＜ 0.05),while the residual refraction and ocular symptom score were higher than those of dry eye patients (all P ＜ 0.05).Conclusion Dry eye disease may last for a long time and may getting worse after LASIK.Therefore,we should pay more attention to the development of dry eye long after LASIK in young myopic patients.

Objective To study the anatomy of splenic hilum blood vessels in order to thread ligature(endoligature)instead of using stapler during the process of laparoscopic splenectomy and to evaluate the prelimnary clinical results.Methods 41 children patients underwent laparoscopic splenectomy with this technique(endoligature)for various hematologic and autoimmune disorders,including 25 cases of hereditary spherocytosis,13 idiopathic thrombocytopenia purpura,and 3 hypersplenic granulocytopenia.The anatomy of splenic pedicle,the adjacent relation between splenic vessel and pancreas were detected by color Doppler ultrasonography preoperatively.The above-mentioned parameters were compared with that found intraoperatively.Results The relationships of splenic vessel and pancreas was of type Ⅰ in 24 cases and type Ⅱ in 17.In 31 cases,the major splenic blood vessels were ramified into branches 2 cm away from the hilum and in 10 it was within 2 cm as detected by preoperative ultrasonography.These characters were largerly identified by laparoscopic laparotomy,and in all the 41 cases laparoscopic splenectomy was successfully accomplished using this endoligature instead of vasculature stapler.There was no serious complication.The mean operating time was(114 ±31)min,the estimated blood loss was(51 ±23)ml.Conclusions Ultrasonography could identify the anatomic type of splenic vessel,and its relation with the pancreas.Endoligature in the management of splenic pedicles during laparoscopic splenectomy is safe and reliable.

Objective To investigate the relationship between 4G/5G polymorphism in the promotor of plasminogen activator inhibitor-1 (PAI-1) gene and pulmonary thromboembolism (PTE). And to detect whether it plays an important role in the pathogenesis of PTE. Methods The 76 patients with PTE, 74 gender and age matched healthy controls were recruited in this study. Genome DNA was extracted from whole blood using phenol-chloroform. Subjects were genotyped for the 4G/ 5G polymorphism of PAI-1 gene using polymerase chain reaction and restriction fragment length polymorphism analysis. Results Significant difference was found in the frequency of 4G/4G genotype between PTE group and control group (50.0% vs.24.3%,P<0.01). And there were no significant differences in 4G/5G and 5G/5G genotype between the two groups. The 4G allele frequency was higher in PTE group than in control group (72.4% vs. 55.4% , P<0.01) . The recessive allele model was informative and the odd ratio of 4G/4G genotype was much higher than of other two genotypes (OR=3.40, P<0.01). Further stratification showed 4G/4G genotype was associated with high risk of PTE for those individuals without traditional environment risk factors. Conclusions The 4G/5G polymorphism of PAI-1 gene is associated with PTE and 4G allele is recessive. 4G/4G genotype increases the risk of PTE for individuals who have no traditional risk factors of PTE.