Objective To study the mechanism of serum thyroxin and insulin change after hemihepatectomy. Methods The hemihepatectomy was performed in rabbits, the fasting peripheral blood samples were drawn on the day prior to surgery, and 24 hour, 48 hour, the first week, one month after operation respectively for monitoring the serum thyroxin and insulin.Results The level of TT 3 was (1.93?0.47) nmol/L, TT 4 (53.56?8.4) nmol/L preoperatively. The levels of TT 3 and TT 4 significantly decreased at 24 hour postoperatively, and gradually rose at 48 hour and up to normal levels in the first month postoperatively. The level of insulin rapidly rose immediately after operation, and began to decrease in the first week, and returned to the preoperative level in one month after operation. Conclusions The syndrome of normal thyroid disease and the syndrome of non thyroid disease can occur after hemihepatectomy; and hyperinsulinemia also can occur after hemihepatectomy.

BACKGROUND:Hip arthroplasty and internal fixation are presently effective therapeutic methods in treatment of femoral neck fracture in the elderly. However, which method can reduce the incidence of postoperative complications remains controversial.
OBJECTIVE:To systematical y review the reoperation, postoperative complications and 1-year and 2-year mortality after hip arthroplasty and internal fixation in the elderly with femoral neck fracture.
METHODS:Pubmed/Medline, EMBASE, and Cochrane CENTRAL databases were retrieved by computer for articles published before May 2013. Systematic review on randomized control ed trials of hip arthroplasty versus internal fixation for femoral neck fractures in the elderly was conducted using the Cochrane Col aboration’s RevMan 5.2 software. Outcome measures included reoperation, main complications related to the surgery and mortality.
RESULTS AND CONCLUSION:Six published randomized control ed trials of nine literatures containing 1 496 cases were involved in this review. Meta-analysis results indicated that reoperation rate was greater in the internal fixation group within and more than 2 years after the surgery compared with the hip arthroplasty group (P<0.000 01). Compared with hip arthroplasty group, internal fixation significantly increased the main complications related to the surgery [OR=8.79, 95%CI(6.50-11.88), P<0.000 01]. No significant difference in 1-year and 2-year mortality after surgery was detected between the internal fixation and hip arthroplasty groups [OR=0.85, 95%CI(0.66-1.11), P=0.23;OR=0.88, 95%CI(0.70-1.10), P=0.27]. These data suggested that the long-term reoperation rate and incidence of main complications were obviously higher in internal fixation compared with hip arthroplasty for femoral neck fracture in the elderly, and no significant difference in 1-year and 2-year mortality after the surgery was detectable between the two methods. Clinical recommended hip arthroplasty in the repair of femoral neck fracture in the elderly.

Objective To investigate the application value of percutaneous sinus-tract cholangioscopy in the diagnosis and treatment of residual intra-and extra-hepatic bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 1 045 patients with intra-and extra-hepatic bile duct stones who underwent percutaneous sinus-tract cholangioscopy or stone extraction in the Second Affiliated Hospital of Zhejiang University from January 2003 to June 2016 were collected.Patients received percutaneous sinus-tract cholangioscopy or stone extraction at 6-8 weeks after T tube drainage.Observation indicators:(1) diagnosis and stone extraction situstions:cases with residual stones,stone extraction frequency and clearance rate;the critics of clearance rate are no residual stone dnring operation combined with B ultrasound or T-tube cholangiography;(2) postoperative complications:incidence and management of postoperative complications,prognosis and ClavienDindo classification for postoperative complication;(3) follow-up situation.T-tube was removed when there was no residual stone.Patients were followed up by outpatient examination up to April 2017.B ultrasound reexamination was performed to detect the recurrence of stone once every 3-6 months.Results (1) Diagnosis and stone extraction situstions:among 1 045 patients,results of cholangioscopy showed 147 wihout bile duct stones and 898with bile duct stones.Of 898 patients,2 618 times cholangioscopic explorations for stone extraction were performed,with a maximum frequency of 16 times,and 851 had stones clearance,with a overall clearance rate of 94.77％(851/898).The clearance rates of extra-and intra-hepatic bile duct stones were 100.00％(221/221) and 93.06％(630/677).Of 47 patients with residual stones,16 didn't receive cholangioscopy due to branches stricture or occlusion of intrahepatic duct,13 failed to take out stone due to T-tube dislodgement (9 cases) and improper placement (4 cases) induced closed T-tube sinus tract,7 had T-tube sinus tract duodenal fistula,6 gave up stone extraction,3 was due to longer sinus tract induced bending and 2 was due to T-tube sinus tract fracture.(2)Postoperative complications:among 1 045 patients,297 had level Ⅰ-Ⅱ mild complications and 13 had level Ⅲand above severe complications.The common complications included fever,vomiting,diarrhea and so on;the special complications included T-tube sinus tract duodenal fistula of 13 patients,T-tube sinus tract fracture of 4 patients,rupture of broken stones pole of 3 patients,massive hemobilia of 2 patients,acute pancreatitis of 2patients and cardiac arrest of 1 patient.The above complications were improved by symptomatic and supportive treatments.(3) Follow-up situation:among 1 045 patients,558 received long-term follow-up,with follow-up time of 10-171 months and a median time of 79 months.Eight-four patients had stone recurrence.Of 13 patients with recurrence of extrahepatic bile duct stones,7 took out stones by endoscopic retrograde cholangio pancreatography (ERCP) and 6 underwent reoperations.Of 71 patients with recurrence of intrahepatic bile duct stones,43underwent reoperations and 28 received conservative treatment.Conclusions Percutaneous sinus-tract cholangioscopy for residual intra-and extra-hepatic bile duct stones is safe and effective,with good diagnosis and treatment values and a high clerance rate.The integrity of T-tube sinus-tract is a key of complete stones removal.

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P < 0.05). (2) The cervical curvature index in the group A was significantly improved (P < 0.05), but the index had no significant change in the group B. (3) The axial systems were significantly improved in both groups, especially in the group A (P < 0.05). (4) The neurological function was significantly improved in both groups (P < 0.05), which showed no significant difference between two groups (P > 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

Objective Toexplorethefeasibilityandaccuracyofsegmentationofthethalamusinhealthymaleswithgraymatter volumecovariance(GMVC)covariancepattern.Methods T1 3DstructuralMRIdatawerecollectedin103 maleparticipants [age from19to50y,mean＝(35.5±7.7)y,educationfrom6to16y,mean＝(10.5±2.3)y].AfterpreprocessedbyCAT12softwarewith standardprocedure (registration,segmentation,modulationandsmooth),thevoxelGwisebilateralthalamusgray mattervolume (GMV)andthewholebrain’svoxelGwiseGMVdatawereextractedtocalculatethecovariancematrixofallparticipants.ExtendedKGmeans clusteringalgorithm wasappliedtosegmentthalamusintosubGareas.RandomsubGsamplingandcrossingGvalidationtechniquewere usedtogenerate100subGdatasetsandverifythesimilarityindex.Cramers’V (CV)wascalculatedandtheKrelevanttothehighest meanofCV wasdeterminedastheoptimalnumberofsubGareasforthalamus.Results Theleftandrightthalamuswereoptimally segmentedinto11and13subGareasbyGMVcovariancepattern.BoththeleftandrightthalamuscomprisesAnteriorNuclear,ventral anteriornucleus,lateraldorsalnucleus,lateralposteriornucleus,ventrallateralnucleus,ventralposteriormedialnucleus,ventralposterior lateralnucleus,midlinenucleus,medialdorsalnucleusandpulvinar.Additionally,fortherightthalamus,anteriornucleargroupwas dividedinto2parts,dorsalpartandventralpart,andthemidlinenucleusintomedialpartandlateralpart.Thelateraldorsalandlateral posteriornucleusweremergedintolateralnucleargroup.Fortheleftthalamus,thelateralposteriornucleuswasfurtherdividedinto2 parts,anteriorpartandposteriorpart.Thesegmentationresultswerealmostalinewiththeanatomical14partitionofthalamus.Conclusion TheparcellationbasedonGMVCcovariancepatternisaneffectiveandreliabletoolforsegmentationofbraingraymatternucleus. Ourfindingsprovideexperimentbasisforthalamusfunctionalandstructuralstudyinthefutureandoptimaltreatmenttargetforneurosurgery anddeepbrainstimulustherapy.

Objective To explore the application effectiveness of medical team resource management model in the first aid green channel of acute ischemic stroke (AIS). Methods A total of 215 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2015 to October 2017 as an observation group.The observation group adopted AIS first aid green channel based on medical team resource management mode.A total of 61 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2013 to October 2015 as a control group.The control group adopted three districts and four treatment procedures.The time course of intravenous thrombolysis was compared between the two groups and to compare the satisfaction of the two groups with different AIS procedures. Results Application of medical team resource management model to establish a dedicated first aid green channel, the key links were significantly shortened,Door-to-Needle Time (DNT) decreased from (114.84 ± 8.05) minutes prior to establishment to (57.63 ± 6.30) minutes, the difference was statistically significant (t=51.263, P<0.05), the satisfaction degree of the medical staff was improved,the overall satisfaction increased from (2.86 ± 0.20) before establishment to (4.27 ± 0.20) points, the difference was statistically significant (t=-34.368,P<0.05).Conclusions The medical team resource management model applied to the treatment of AIS patients, the establishment of multidisciplinary integration of first aid green channel, to strengthen the team to effectively improve the timeliness of the key aspects of intravenous thrombolysis, shorten DNT, improve the quality of treatment of patients.

Objective To investigate the clinical significance of biochemical markers in EBC and serum in patients with bronchial asthma and chronic obstructive pulmonary disease overlap syndrome(ACOS). Methods We selected Patients with chronic airway inflammatory diseases in our hospital,These patients underwent clinical trial after the stable phase,including 18 ACOS patients,22 asthma patients,24 COPD patients and 20 healthy non-smokers in the same period.8-isoPG and other inflammatory factors levels in EBC and serum were measured in the selected patients. A comparative analysis was performed. Results The levels of EBC 8-isoPG in the ACOS group were significantly higher than those in the healthy control group,The levels of serum and EBC 8-isoPG in the ACOS group were significantly higher than the asthma group and the COPD group(P < 0.05). The level of 8-isoPG in EBC was not related to age,smoking index,weight,and FEV1value(P>0.05).Conclusions Inflam-matory factors including 8-isoPG,are involved in chronic inflammation in lung tissues of patients with ACOS. 8-isoPG in EBC may have potential value in identifying ACOS from COPD and asthma as biomarkers and deserve further study.

Objective: To study the clinicopathologic features of intraductal papillary neoplasm of the bile duct(IPNB) and to analyze the diagnostic and therapeutic patterns. Methods: The data of 46 patients with IPNB undergoing surgery in Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to November 2017 were retrospectively analyzed.There were 23 males and 23 females with age of (64±8)years.Patients were followed up by clinics and telephone inquiry.Categorical data were compared with χ² test or Fisher′s exact test. Results: Abdominal pain(in 31 patients), fever (in 15 patients) and jaundice (in 11 patients) were the most common symptoms.Twenty-five patients were accompanied with cholangiolithiasis and 25 were accompanied with liver atrophy.Preoperative laboratory examination was mainly manifested as the abnormal liver function caused by biliary obstruction.Typical imaging findings included bile duct dilation (in 45 patients) and mass within bile duct (in 22 patients). All the patients were diagnosed as IPNB histopathologically.Among them, high-grade intraepithelial neoplasia and related adenocarcinoma were more common in mucus-hypersecretion IPNB ((13/15 vs. 51.6%(16/31))(χ²=5.331, P=0.021). Hepatectomy was performed in 25 patients, hepatectomy combined with biliary resection and reconstruction in 12 cases, biliary resection and reconstruction in 3 cases, pancreatoduodenectomy in 3 cases, hepatopancreaticoduodenectomy in 1 case, liver transplantation in 1 case and radiofrequency ablation in 1 case.Forty-one patients were followed up with a median of 30 (12, 41) months.Seven patients suffered recurrence and 6 died. Conclusion IPNB is a rare disease with limited knowledge currently.Images are the main diagnositc means and surgery is the first choice.

Objective:To understand the current situation of the head nurses of orthopedics department on bleeding risk assessment and management in the prevention of DVT, to provide a reference for future clinical practice of bleeding risk assessment.Methods:Using phenomenological research methods, five head nurses of orthopedics department were interviewed one-on-one and analyzed by Colaizzi ′s phenomenological analysis. Results:Four themes were refined for the awareness and management of bleeding risk assessment in DVT prevention, mainly focusing on risk assessment, choice of assessment timing, multiple risk assessment methods, and unclear grading attitudes.Conclusions:The bleeding risk assessment work needs to be further explored. It is necessary to further scientifically clarify the timing and methods of bleeding risk assessment, effectively guide clinical practice, strengthen nurses ′ awareness of bleeding risk classification, and promote clinical nursing practice, so as to better conduct bleeding assessment and Care.

Objective:To explore the diagnostic value of the toxicant and drug detection in clinical poisoning diseases and analyze the clinical characteristics of patients with positive poison test.Methods:This study was a multicenter retrospective cohort study. Sampling and clinical information data were collected between October 1, 2020 and September 30, 2022 from 41 tertiary hospitals in and around Jiangsu province. The clinical characteristics of patients with positive toxicology tests were analyzed, and the correlation between the drug sampling situation and the test results was analyzed..Results:A total of 895 patients with clinical diagnosis or suspected poisoning were enrolled in this study. Among them, 652 patients had positive results, accounting for 72.85%. Among all positive patients, 506 patients were exposed to a single poison and 147 patients were exposed to multiple poisons. The top three poisons were pesticide herbicides (202 cases, 30.98%), sedative and psychotropic drugs (151 cases, 23.16%), and pesticide insecticides (97 cases, 14.88%). Among 541 patients with clear exposure history, the positive rate was 78.19%, and among 354 patients with unclear exposure history, the positive rate was 64.69%. The top three poisons (drugs) of patients with unclear exposure history were sedative and psychotropic (82, 12.58%), herbicide (26, 3.99%), and rodenticide (22, 3.37%). Patients who admitted to hospital for unexplained consciousness disorder, abnormal blood coagulation function and multiple organ dysfunction were more likely to obtain positive poison test results.Conclusions:There is uncertainty in the exposure history of poisoning diseases, so it is necessary to improve the detection of toxic substances as soon as possible. Toxicant testing should be considered when patients have impaired consciousness, abnormal coagulation function and multiple organ dysfunction.