Objective To compare the surgical effects of laparoscopy and open mini-incision surgery in cholelithotomy with the gallbladder being preserved.MethodsFrom April 2006 to May 2008,63 cases of cholelithiasis received cholelithotomy with the gallbladder being preserved in our hospital by laparoscopy(n=33) or mini-incision open surgery(n=30).The operation time,recovery time of gastrointestinal function,rates of postoperative analgesics use and complications,inpatient charge,and drug expense after the operation were analyzed.ResultsThe mean operation time in laparoscopy group was significantly longer than that in open group [(66.4?10.6) min vs(60.6?9.8) min,t=2.248,P=0.020)].And the inpatient charge in laparoscopy group was significantly higher than that in the open group [(7865?992) yuan vs(6995?825) yuan,t=3.765,P=0.000)].Whereas,the recovery time of the gastrointestinal tract and postoperative hospital stay in the laparoscopy group was significantly shorter than those in the other [(22.7?6.9) h vs(36.9?17.2) h,t=-4.374,P=0.000);(4.8?1.5)d vs(10.0?7.4) d,t=-3.951,P=0.000)].In the laparoscopy group,only one patient showed complication(periumbilical infection) after the treatment,while in the open group,2 patients developed incisional hematoma,2 showed incisional infection,3 had pelvic effusion,and 1 suffered from adhesive intestinal obstruction(?2=5.369,P=0.020).ConclusionsLaparoscopy is a good choice for cholelithotomy with the gallbladder being preserved,for it is minimally invasive,and thus leads to less surgical trauma,quicker recovery,fewer complications,and shorter hospital stay after the procedure.

Objective To evaluate the efficacy and safety of tacrolimus (TAC) for treatment of Henoch-SchSnlein purpura nephritis in children.Methods Forty children with Henoch-SchSnlein purpura nephritis (pathological grade Ⅲ-Ⅵ) in Children's Hospital Affiliated to Soochow University from January 2013 to June 2016 were selected and divided into TAC group (n =19) and cyclophosphamide (CTX) group (n =21).The children in TAC group were given TAC orally;the children in CTX group were given CTX pulse therapy intravenously.The 24 h urine protein,urine red blood cell count,serum albumin,serum creatinine and blood urea nitrogen of children before treatment and after 6 months treatment were observed and compared between the two groups.The treatment effects and adverse reactions of patients were observed and compared between the two groups.Results There was no statistic difference in the 24 h urine protein,urine red blood cells count,serum albumin,blood creatinine and blood urea nitrogen levels of children between the two groups before treatment (P ＞ 0.05).The 24 h urinary protein and urine red blood cells count of children after 6 months of treatment in the two groups were significantly lower than those before treatment (P ＜ 0.05);there was no statistic difference in the serum albumin,serum creatinine and blood urea nitrogen levels of children in the two groups before treatment and after 6 months of treatment (P ＞ 0.05).Mter 6 months of treatment,the 24 h urine protein and urine red blood cells count of children in TAC group were significantly lower than those in the CTX group (P ＜ 0.05);there was no statistic difference in the serum albumin,serum creatinine and blood urea nitrogen levels of children between the two groups (P ＞ 0.05).After 6 months treatment,the effective rate of children in the TAC group was significantly higher than that in the CTX group (x2 =4.607,P ＜ 0.05).The incidence of adverse reactions of children in the TAC group was significantly lower than that in the CTX group (x2 =4.043,P ＜ 0.05).Conclusion TAC is effective in treatment of Henoch-Sch(o)nlein purpura nephritis in children.It is easy to take,and has less adverse reactions.

Objective　To explore the relationship of defense style and mental health in student of middle school. Method 203 middle student were investigated with Defense Style Questionnaire (DSQ) and Symptom Check List-90 (SCL-90). Results There were no significant difference for 4 factors of DSQ in man／female and advance middle school or not(P>0.05); there were significant difference for immature defense mechanism and middle type factor ,and conceal factor in high-symptom score team with that of low-symptom sore team(P<0.01) and it is positive-correlation with each factor-score and total score of SCL-90. Conclusion School and family need to pay attention to the higher correlation in the total score of SCL-90 with immature defense mechanism and middle type factor and conceal factor.

Objective To investigate changes in the expression of apurinic/apyrimidinic endonuclease (APE) and the oxidative DNA damage marker 8 OHdG in distant hippocampus regions of the rat brain after focal cerebral ischemia of the middle cerebral artery.Methods SD rats were divided into the sham surgery group and the pMCAO group (induced by middle cerebral artery occlusion).Pathological changes in brain tissues were examined at 2 h,6 h,12 h,24 h,48 h and 72 h.The expression of APE and 8-OHdG was measured by immunohistochemical staining methods.TUNEL staining was performed to detect apoptosis.Results Reduction of APE expression in the CA1 region of the hippocampus on the ischemia side appeared at 2 h in the pMCAO group and continued as ischemia persisted (F=11.91,P＜0.05).The expression of 8OHdG and TUNEL immunoreactivity in the CA1 region of the hippocampus on the ischemia side were first observed at 6h in the pMCAO group and intensified during the remainder of induced ischemia (F=9.23 and 10.46 respectively,P＜0.05 for both).Compared with the sham group,8-OHdG expression and TUNEL immunoreactivity in the pMCAO group were at nearly the same levels from 24 h to 72h.Conclusions Oxidative DNA damage occurs in hippocampus regions of the rat brain after experimentally induced focal cerebral ischemia of the middle cerebral artery.APE expression declines in regions distant from focal cerebral ischemia.Development and accumulation of oxidative DNA damage can induce apoptosis in certain brain regions.

Objective To investigate the risk factors of bronchopulmonary dysplasia(BPD)in very low birth weight infant.Methods The clinical data of 49 very low birth weight infants in our NICU from Sep 2006 to Sep 2009 were reviewed,and divided into BPD group(n =15)and without BPD group(n =34).The risk factors of BPD were analysed.Results Compared with the infants without BPD,there were significant differences in gestational age[(29.30 ± 1.48)week vs(30.54 ± 1.60)week],hospital-acquired infection(9 cases vs 10 cases),intrauterine infection(9 cases vs 8 cases),the time for continuous positive airway pressure(CPAP)[(12.47 ± 5.83)d vs(4.24 ± 4.19)d],the time for hyperoxia[(1.47 ± 1.41)d vs (0.18 ±0.63)d],patent ductus arteriosus(5 cases vs 1 cases)(P＜0.05).Logistic regression revealed that intrauterine infection and the time for CPAP were independent risk factors of BPD(P ＜0.05).Conclusion Prophylaxis of intrauterine infection may decrease the mortality and severity of BPD.The prolonged time for CPAP may predict the risk of BPD.

Objective:To investigate the etiology, clinical characteristics and outcome of severe pneumonia-associated hemophagocytic lymphohistiocytosis, and to analyze the risk factors for mortality.Methods:Clinical data of patients with severe pneumonia-associated hemophagocytic lymphohistiocytosis admitted to Shenzhen Children′s Hospital from February 2009 to February 2019 were retrospectively analyzed.The data included clinical characteristics, etiology, clinical manifestations, laboratory data, treatment and outcomes of the patients.The clinical characteristics and laboratory data of the survival group and the death group were compared by independent sample t-test. Results:(1) Clinical characteristics: the patients were aged from 3 months to 8 years and 7 months, including 15 males and 15 females.Severe pneumonia-associated hemophagocytic lymphohistiocytosis accounted for 2.74% (30/1 096 cases) of severe pneumonia in the same period.(2) Etiology: Mycoplasma pneumoniae infection was found in 8 cases (8/30 cases, 26.67%), virus infection in 7 cases (7/30 cases, 23.33%, including 5 cases with adenovirus infection, 1 case with EB virus infection, and 1 case with cytomegalovirus infection), Mycoplasma pneumoniae complicated with adenovirus infection in 4 cases (4/30 cases, 13.33%), bacterial infection in 3 cases (3/30 cases, 10%), and fungal infection in 2 cases, Mycobacterium tuberculosis infection in 1 case.The pathogens were not identified in 5 patients.(3) Clinical manifestations: fever and hepatomegaly were present in all patients.Besides, 86.67% (26/30)patients had fever duration more than 10 days, 83.33% (25/30 cases) patients had cough, 76.66% (23/30 cases) patients had splenomegaly, and 33.33% (10/30 cases) patients had nervous system symptoms.Laboratory data showed varying degrees of reduction of binary and ternary systems in 80.00%(24/30 cases) of the patients.Liver function impairment was found in half of the patients, and serum ferritin and lactate dehydrogenase levels were elevated in all patients.(4) The mortality rate was 30.00% (9/30 cases). The differences in age, hypertriglyceridemia and high serum ferritin levels between the survival and death groups were significant (all P<0.05). Conclusions:Severe pneumonia-associated hemophagocytic lymphohistiocytosis is a disease with a high mortality rate.Patients with Mycoplasma pneumoniae and adenovirus pneumonia are more likely to suffer from secondary hemophagocytic lymphohistiocytosis.Younger age, hypertriglyceridemia and high serum ferritin levels are indicative of poor prognosis.

Objective To explore the responses of antigen-specific T cells stimulated by hepatitis B virus(HBV)-specific proteins in chronic hepatitis B patients accepting antiviral therapy. Methods Seventeen patients with chronic hepatitis B (CHB) accepting antiviral therapy were included in this study. The peripheral blood monocular cell ( PBMC) were separated from the whole blood collected at the three different time of before and one and three months after accepting antiviral therapy. ELISPOT assay was used to detect the frequency and strength of secreting IFN-γ cells of PBMC stimulated by HBsAg, HBcAg and HBeAg. HBV virus loading, HBsAg, HBeAg, ALT and AST in serum were detected at the same time. Results After three months therapy, ALT, TBiL were improved in all patients, and HBV DNA level were dropped and undetectable in 11 cases. The rates of T cell response in patients to HBV specific proteins were 64. 7% , 76. 5% and 82. 4% at the time of before and one and three months after accepting antiviral therapy, respectively. The frequency of responses of antigen-specific T cells stimulated by HBcAg was higher than that stimulated by HBsAg or HBeAg, and the frequency was enhanced after antiviral therapy. The average response magnitude was expressed as spot forming cells (SFC) per million input cells. SFC of T cell responses to HBcAg was also higher than to HBsAg or HBeAg. There was no significant difference in SFC of T cell responses to HBsAg or HBeAg at the time of before and after antiviral therapy, but there were significant difference in SFC of T cell responses to HBcAg at the time of before and after antiviral therapy. SFC of T cell responses to HBcAg was negatively associated with HBV DNA, and no associated with level of ALT in serum. Conclusion The responses of antigen-specific T cells were improved in CHB patients accepting antiviral therapy which associated with the decrease of HBV DNA. It suggested to investigate HBV specific T cell responses was important.

Objective:To investigate the effect of improved epidural catheter labor analgesia on the maternal and infant outcome of re-pregnant parturients with scar uterus.Method:A total of 100 cases of re-pregnant women with scarred uterus admitted to Shexian Hospital from January 2019 to January 2020 were selected. According to the random number table, they were divided into the observation group (50 cases) and the control group (50 cases). Parturients in the observation group received a modified epidural catheter for labor analgesia, and parturients in the control group received conventional epidural analgesia. The complications of epidural vascular injury, difficulty in catheterization, multiple catheterization, loss of catheter resistance, urinary retention, intrauterine distress, neonatal asphyxia, postpartum hemorrhage, Apgar score, maternal and neonatal outcomes were compared between the two groups.Results:The rate of epidural vascular injury, difficulty in catheter placement, multiple catheter placement and disappearance of catheter resistancein the observation group were lower than those in the control group: 2.0%(1/50) vs. 14.0%(7/50), 2.0%(1/50) vs. 16.0%(8/50), 0 vs. 8.0% (4/50), 8.0% (4/50) vs. 24.0% (12/50), χ2 = 4.89, 5.98, 4.17, 4.76, P<0.05. The rate of urinary retention, intrauterine distress and neonatal asphyxia in the observation group were lower than those in the control group: 4.0%(2/50) vs. 16.0%(8/50), 2.0%(1/50) vs. 14.0%(7/50), 0 vs. 8.0%(4/50), χ2 = 4.00, 4.89, 4.17, P<0.05. Conclusions:Improved epidural catheter delivery analgesia for patients with scarred uterus can achieve significant results, effectively reduce the incidence of vascular injury, and improve the maternal and infant outcome.

OBJECTIVETo establish a new diagnostic method for Down's syndrome using polymerase chain reaction (PCR).

METHODSDNA extracted from five healthy individuals and five Down's syndrome patients was amplified in six specific tetranucleotide repeat loci on chromosome 21 using PCR. An accurate diagnosis was made by analyzing allelic distribution at each locus.

RESULTSAll Down's syndrome patients were identified as having at least two loci with three alleles, while none of the healthy individuals had three alleles. In addition, when two alleles were identified for a particular locus in the Down's syndrome samples, it was more likely that the intensity ratio between the two alleles was close to 2:1.

CONCLUSIONThe molecular method can provide a fast, accurate, and economical alternation for the traditional cytogenetic diagnostic method for Down's syndrome.

Objective:To evaluate the clinical efficacy of Chaihu Longgu Muli Decoction in the treatment of post-stroke depression.Methods:A total of 130 patients with post-stroke depression who met the inclusion criteria from April 2019 to December 2020 were enrolled in the study. The patients were randomly divided into two groups with 65 cases in each group. The control group was treated with Flupentixol and melitracen tablets on the basis of routine treatment, and the observation group was treated with Chaihu Longgu Muli Decoction on the basis of routine treatment. Both groups were treated for 4 weeks. TCM syndrome scores were performed before and after treatment. The levels of serum Hcy and hs CRP, Plasma 5-HT and brain-derived neurotrophic factor (BDNF) were detected by ELISA, and the ratio of neutrophils to lymphoblasts (NLR) was recorded.Results:The response rate was 92.3% (60/65) in the observation group and 75.4% (49/65) in the control group. There was significant difference between the two groups ( χ2=6.87, P=0.009). After treatment, the serum Hcy [(11.87±1.56) μmol/L vs. (16.69±1.77) μmol/L, t=16.47] and hs-CRP [(7.81±1.66) mg/L vs. (16.45±4.87) mg/L, t=13.54] in the observation group were significantly lower than those in the control group ( P<0.01), and Plasma 5-HT [(150.41±17.54) μg/L vs. (123.24±16.02) μg/L, t=9.22], BDNF [(19.45±2.48) μg/L vs. (12.56 ± 2.23) μg/L, t=16.66] were significantly higher than those in the control group ( P<0.01). After treatment, the NLR and TCM syndrome scores in the observation group were significantly lower than those in the control group ( t values were 6.03 and 7.15, respectively, all Ps<0.01). Conclusion:The Chaihu Longgu Muli Decoction combined with western medicine treatment can correct the levels of Hcy, hs-CRP, 5-HT, BDNF and NLR in peripheral blood, alleviate the state of depression and anxiety of patients with post-stroke depression.