Objective To evaluate the diagnostic value of MSCT in abdominal aortic aneurysm(AAA).Methods 26 patients suspected AAA and admitted to our hospital were studied and checked by MSCT prospectively.The accuracy and features of MSCT were analyzed. Results 26 patients were diagnosed as AAA by MSCT,in which 17 cases were true AAA,and 9 were false AAA.MSCT for true AAA patients showed fusiform dilatation of abdominal aorta bulging to the left,and showed visible thrombus and calcification in aneurysm wall of residual tumor around the cavity when aneurysm ruptured.MSCT of false AAA showed aortic eccentric enlargement lump,which could be outside the boundaries of vascular calcification.25 cases of AAA were surgically confirmed,and the coincidence rate of MSCT and pathology was as high as 96.1% (25/26).Arterial wall calcification was found in all patients,in which 17 cases had mural thrombus.Conclusion MSCT is a safe,effective and non-invasive diagnostic technology for early detection and treatment of AAA, which may help determine patient’s condition and guide the treatment.

Objective To investigate peripheral blood T lymphocyte subsets and NK cells changes in the diffuse large B cell lymphoma (DLBCL) patients before and after chemotherapy,and analyse the relationship between the results and treatment.Methods Collect the 47 patients venous blood of the effective treatment DLBCL by pathology.T lymphocyte subsets and NK cells were determined by flow cytometric.Analyse the results statistically significant difference before treatment,the second chemotherapy cycle and the fourth chenmotherapy cycle compared with 50 healthy control persons.Results The levels of CD3+,CD4+,CD4+/CD8+ NK cells in DLBCL patients before chemotherapy [(70.04±8.87)％,(42.79±6.06)％,(1.68±0.59)％,(14.40±6.02)％]were lower than healthy controls [(63.89±6.67)％,(32.72±5.77)％,(0.85±0.25)％,(9.95±5.24)％](P ＜ 0.05),and the level of CD8+ cells is higher than the healthy controls [(27.21 ±6.54)％ vs.(39.92±7.11)％](P ＜ 0.05).The levels of CD3+,CD4+,CD4+/CD8+ cells had significant difference between the second and the fourth chemotherapy cycle in DLBCL patients (P ＜ 0.05).The levels of CD3+,CD4+,CD8+,CD4+/CD8+,NK cells had significant difference between the fourth chemotherapy cycle DLBCL patients and the DLBCL patients before chemotherapy (P ＜ 0.05).Conclusion The DLBCL patients exist immunosuppression before chemotherapy.Peripheral T lymphocyte subsets and NK cells can be used as good reflect of the cellular immune function in DLBCL patients.Clinical parameters can be used for the immune function monitoring and providing guidance for the treatment options.

Objective To investigate the effect of flurbiprofen axetil on perioperative plasma levels of prostaglandin E2 (PGE2) and β-endorphine (β-EP) in patients after remifentanil-based anesthesia.Methods Sixty ASA Ⅱ patients of both sexes,aged 40-64 yr,weighing 50-75 kg,undergoing resection of esophageal cancer,were randomly divided into 3 groups (n =20 each):intralipid group (group A),flurbiprofen axetil pretreatment + postoperative analgesia with flurbiprofen axetil group (group B) and flurbiprofen axetil pretreatment group (group C).Anesthesia was induced with propofol,remifentanil and rocuronium and maintained with propofol,remifentanil and intermittent iv boluses of rocuronium.In group A,intralipid 0.2 ml/kg was injected intravenously at 30 min before operation and patient-controlled intravenous analgesia (PCIA) with fentanyl 15μg/kg + intralipid 0.2 ml/kg was used for postoperative analgesia.In group B,flurbiprofen axetil 2 mg/kg was injected intravenously at 30 min before operation and PCIA with fentanyl 15 μg/kg + flurbiprofen axetil 2 mg/kg was used for postoperative analgesia.In group C,flurbiprofen axetil 2 mg/kg was injected intravenously at 30 min before operation and PCIA with fentanyl 15 μg/kg + intralipid 0.2 ml/kg was used for postoperative analgesia.PCIA solution contained fentanyl 15 μg/kg,flurbiprofen axetil 2 mg/kg and intralipid 0.2 ml/kg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose,a 10 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of 5 ml starting from 30 min before the end of operation.VAS score was maintained ＜ 3 after operation,and tramadol 50 mg was injected intravenously when VAS ≥ 4 after operation.The amount of remifentanil used during operation and the number of successfully delivered doses and the number of attempts,requirement for tramadol,apnea and severer hypotension were recorded within 48 h after operation.Blood samples were taken immediately before induction of anesthesia,at the end of operation,24 and 48 h after operation (T1-4) for determination of plasma β-EP and PGE2 concentrations.Results There was no significant difference in the amount of remifentanil used among the three groups (P ＞ 0.05).Compared with group A,the number of successfully delivered doses,the number of attempts and the requirement for tramadol were decreased,and the concentration of plasma PGE2 at T2,3 were significantly decreased in groups B and C,and the concentrations of plasma β-EP at T3,4 in group B and at T4 in group C were significantly increased (P ＜ 0.05).Compared with group B,the number of successfully delivered doses,the number of attempts and requirement for tramadol were significantly increased,and the concentration of plasma β-EP at T3,4 wassignificantly decreased in group C (P ＜ 0.05).Compared with the baseline value at T1,the concentrations of PGE2 were significantly increased at T2,3,and the concentration of plasma β-EP was significantly increased at T2,but decreased at T4 in group A,and the concentrations of β-EP at T3,4 were significantly increased in group B (P ＜ 0.05).There was no significant difference in the concentrations of PGE2 and β-EP between the four time points in group C (P ＞ 0.05).Apnea and severer hypotension were not found in the three groups.Conclusion The mechanism by which flurbiprofen axetil reduces postoperative opioid tolerance in patients after remifentanil-based anesthesia may be related to the decrease in PGE2 levels and increase in β-EP levels.

Objective:To explore the effect of venetoclax-based therapy on relapsed/refractory multiple myeloma (MM) patients harboring t(11;14).Methods:The data of a relapsed/refractory MM patient harboring t(11;14) treated with venetoclax-based regimen admitted to Shanghai Changzheng Hospital in June 2019 was retrospectively analyzed and the literatures were reviewed.Results:The relapsed/refractory MM patient harboring t(11;14) had progression of disease after 3 lines of therapies, and then was treated with the selective bcl-2 inhibitor venetoclax combined with daratumumab and dexamethasone. As a result, the patient achieved partial remission and better hemogram recovery. The Eastern Cooperative Oncology Group (ECOG) score of physical status decreased from 3 to 1, and the quality of life was improved significantly.Conclusions:The relapsed/refractory MM patients harboring t(11;14) could benefit from venetoclax-based therapy. In the future, the safety, sensitivity and other performances of venetoclax in the treatment of MM should be further explored.

OBJECTIVE To know the compliance and it′s impact factors of hand hygiene of healthcare workers.METHODS The wards and healthcare workers were sampled randomly.Survey the compliance,qualified rate and impact factors of hand hygiene of healthcare workers when they didn′t know to be observed by special training staffs.RESULTS The compliance and the qualified rate of hand hygiene was 30.2% bothly,and be affected by the time before or after operation,occupations and work post.The factors causing low qualified rate were anenough time and improper technique for washing hand,and drying hand wrong.CONCLUSIONS The hand hygiene for healthcare workers in hospitals should be strengthened.

OBJECTIVE To investigate the characteristic of multidrug resistant organisms(MDROs) in hospital or community-acquired infection,so that it can approach effective infection management.METHODS Patients infected by Staphylococcus,Enterococcus,Escherichia coli,Klpneumoniae and A.baumanni were investigated in a Hospital from June 2008 to May 2009.RESULTS Among total 929 strains of bacilli from patients,367 were MDROs infection,the detection rate of MDROs,CA-MDROs or HA-MDROs was 39.5%,35.6% and 51.4% respectioety infection;The detection rate of MDROs from HAI patients was significantly higher than that from CAI patients(?2=19.2 P=0.00).There were differences between HA-MDROs and CA-MDROs in different departments.MRSA,ESBLs-kp And PDR-AB were isolated mostly from sputum of patients,and ESBLs E.coli mostly from urine of CAI patients.CONCLUSIONS It is important to analyze the characteristic of HA-MDROs or CA-MDROs in the treatment of infection or use of antibiotics from experience.MDROs control is full of difficulties as a result of high CA-MDROs rates.

Objective To investigate the efficacy of prophylactic pancreatic stent placement and nonsteroidal antiinflammatory drugs( NSAIDs) for the prevention of post?endoscopic retrograde cholangiopan?creatography(ERCP) pancreatitis(PEP). Methods A total of 623 patients with high risk factors for PEP were treated with prophylactic pancreatic stent placement ( 145 patients, group A) or rectal NSAIDs( 478 pa?tients, group B) for PEP prevention by using the propensity score matching( PSM) analysis. Incidence of PEP, moderate and severe PEP were investigated. According to risk factors of PEP, indications of prophy?lactic pancreatic stent placement were analysed. Results Of 623 patients with high risk factors, 145 pairs were generated after PSM.Pancreatitis occurred in 32 patients,10 (6?9%) in group A and 22 (15?2%) in group B( P<0?05 ) . Moderate?to?severe pancreatitis developed in 5 ( 3?4%) patients in group A and 14 (9?7%) patients in group B(P<0?05).Risk factors of post?ERCP PEP were cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and history of ampullectomy. Conclusion Although the NSAIDs represent an easy, inexpensive treatment, prophylactic pancreatic stent placement is still a better prevention strategy for PEP.Prophylactic pancreatic stents should be recommended to those with risk factors including cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and ampullectomy.

Objective To explore the effect and mechanism of fluvastatin on the expression of fibronectin(FN) in human peritoneal mesothelial cells (HPMCs) induced by high-glucose peritoneal dialysate (HGPDS).Methods Cultured HPMCs were randomly divided into control,HGPDS,HGPDS plus GSK650394 10-5 mol/L (the competitive inhibitor of SGK1),different concentrations of fluvastatin,fluvastatin 10-6 mol/L and GSK650394 10-5 mol/L alone.The morphology change of HPMC was observed by light microscopy.The cellular viability was detected by MTT colorimetry.The mRNA and protein expressions of serum and glucocorticoid-inducible kinase 1 (SGK1) and FN were detected by RT-PCR,Western blotting or ELISA.Results After incubation with HGPDS,the cell morphology changed from typical cobblestone-like appearance to fibroblast-like appearance,and the cell viability was inhibited significantly (P＜0.05).Fluvastatin 10-6mol/L and GSK650394 could improved the cell morphology and the cell viability injured by HGPDS (P＜0.05).Compared with the normal control group,the mRNA and protein expressions of SGK1 and FN increased significantly in HPMC treated with HGPDS(P＜0.05).GSK650394 significantly decreased the high expression of SGK1 and FN (P＜0.05),also the fluvastatin had same effects as GSK650394 in dose-dependent manner (P＜0.05).Conclusions High-glucose peritoneal dialysate can increase FN expression in human peritoneal mesothelial cells,which can be attenuated by fluvastatin.The protective role of fluvastatin in HPMC may be partially achieved through the signal pathway of SGK1.

Objective To investigate the concentration of Golgi glycoprotein 73(GP73) in ascites, then study the value of GP73 and alpha fetal protein(AFP)in the differential diagnosis of ascites.Methods Totally 96 malignant ascites specimens , 35 benign ascites specimens and their paired serum specimens were collected in the Tumor Hospital Affiliated to Xinjiang Medical University from November 2012 to November 2013.GP73 in serum and ascites were detected by ELISA and AFP in ascites was measured by electrochemical luminescence.The application values of GP 73 and AFP were evaluated through ROC curve.Results In benign ascites group , the difference of GP73 between the ascites ( 16.06 ±9.53 ) ng/ml and the serum (13.69 ±8.87) ng/ml was statistically significant (t=5.026,P<0.001), which showed a good linear correlation (r=0.966,P<0.001).In malignant ascites group, the difference between the ascites (28.37 ±12.02) ng/ml and the serum (16.06 ±9.53) ng/ml was statistically significant (t=10.641,P<0.001), and also showed a good linear correlation (r=0.933,P<0.001).The cutoff values of GP73, AFP and GP73*AFP (GP73 multiplied AFP) for diagnosing the malignant ascites were 17.1 ng/ml, 13.1 ng/ml and 321.The area under ROC curve ( AUC) were 0.795, 0.753 and 0.902 respectively.The AUC of GP73*AFP is the largest.The sensitivity of three index diagnosing the ascites , were 89.6%( 86/96 ) , 88.5%(85/96) and 86.4%(83/96); and the specificity were 60.0%(21/35), 54.2%(19/35) and 85.7%( 30/35 ) respectively.Conclusions Detection of GP73 in ascites specimens has clinical value , GP73*AFP was the best indicators for differential diagnosis of benign and malignant ascites compared to GP73 and AFP.

Objective:To evaluate the clinical efficacy and safety of SpyGlass-guided laser lithotripsy for large common bile duct (CBD) stones with diameter>2 cm.Methods:From August 2015 to August 2018, a total of 157 patients with large CBD stones at the First Affiliated Hospital of Shandong First Medical University who met the inclusion criteria were randomly divided into SpyGlass group ( n=78, underwent SpyGlass-guided laser lithotripsy) and laparoscopic common bile duct exploration (LCBDE) group ( n=79, underwent LCBDE) by using random numbers. Non-inferiority test was used for rates of one-time stone removal and total stone removal, and the non-inferiority margin was set to 10%. The transform rate, incidence of short-term complications, hospital stay, and quality of life (assessed by the gastrointestinal quality of life index) were compared between the two groups. Results:The total success rates of stone clearance were 92.3% (72/78) and 96.2% (76/79) in the SpyGlass group and LCBDE group, respectively ( P=0.023), with valid non-inferiority hypothesis. The one-time stone removal rates were 83.3% (65/78) and 96.2% (76/79), respectively ( P=0.124), with invalid non-inferiority hypothesis. There were no significant differences in the incidence of transform [7.7% (6/78) VS 3.8% (3/79), P=0.294] or short-term complications [5.1% (4/78) VS 10.1% (8/79), P=0.246] between the two groups. Compared with the LCBDE group, the SpyGlass group had a shorter hospital stay (5.65±0.94 d VS 8.84±1.54 d, P=0.001) and higher scores of gastrointestinal quality of life index (1 month after operation: 99.85±4.36 VS 91.51±5.47, P=0.001; 3 months after operation: 131.24±3.32 VS 112.32±7.77, P=0.001). Conclusion:For large CBD stones, the efficacy of SpyGlass-guided laser lithotripsy is not inferior to LCBDE, and it is less invasive. In the future, SpyGlass-guided laser lithotripsy could be an important option for the treatment of large CBD stones.