ObjectiveTo evaluate the value of endoscopy in the diagnosis of biliary tract roundworm disease.Methods32 cases of biliary tract roundworm diseases were diagnosed and treated with fibre (electron) stomach duodenum endoscopy and fibre biliary tract endoscopy under the direct-view.Results32 cases were all clearly diagnosed and the worms were taken out with direct-view endoscopy or direct cholangiography with no complications.ConclusionEndoscopy is effective and accurate for the biliary tract roundworm disease and has the advantage of rapidly dispelling the sufferings of the patients.

Objective To investigate the risk factors of extrahepatie recurrences after curative resection of primary hepatocellular carcinoma (HCC). Methods Clinicopathologic data of 238 curative resected cases of primary HCC were retrospectively reviewed for parameters affecting postoperative extrahepatic recurrences. Results During a median follow-up of 34 months (7 - 78 months), extrahepatic recurrences were observed in 32 out of 238 patients (13.4%). According to univariate analysis, the risk factors for extrahepatic recurrences were preoperative serum a-fetoprotein (AFP) level of > 1000 ng/ml,aspartate aminotransferase level of > 50 IU/L, presence of hepatic vein invasion, neighboring organ invasion, tumor satellites, and lack of tumor capsule formation. Preoperative serum AFP levels of > 1000 ng/ml, hepatic vein invasion, neighboring organ invasion proved to be independent risk factors by multivariate analysis. Conclusions Extrahepatic recurrences after curative resection of HCC was found to be related to preoperative serum AFP level of > 1000 ng/ml, hepatic vein invasion, and neighboring organ invasion.

Objective To evaluate the techniques and the effects of resection of giant hepatic tumors in the caudate lobe of the liver. Methods The clinical data of 33 patients with primary liver carcinoma or benign tumor (>10 cm) in the caudate lobe of the liver surgically treated in our hospital from January 2000 to January 2007 were retrospectively analyzed. Results The total of 33 huge liver tumors with a median diameter of 12.3 cm (10.2-15.3cm) were successfully resected. The types of the hepatectomies conducted were as follows:isolated total caudate lobectomy in 7cases, partial cau-date lobectomy in 8, caudate lobectomy plus other extended hepatectomy in 18. The median operative time was 218 min (120-360 min) and the median intraoperative blood loss 958 ml (400-7000 ml),with operative mortality and morbidity being 0 and 27%, respectively. The postoperative 1-, 3- and 5-year survival rates for the patients with primary liver cancer were 76 %,52% and 24%, respectively. Con-clusion The hepatic tumors of caudate lobe, when larger than 10 cm in diameter, frequently involves all the hepatic portal,hepatocaval confluence and retrohepatic IVC. Though it is sophisticated in tech-nique, surgical resection of this kind of tumor is safe, effective and of the first choice.

Objective To identify the risk factors for osteoporosis in patients with hemiplegia. Methods The total body bone mineral density (BMD) of 366 patients with hemiplegia in the stage of rehabilitation was measured with dual-energy X-ray absorptiometry. The data of the patients were analyzed with multiple logistic regressions. Results The incidence of osteoporosis was 15.3 % (56/366) in the cohort. ≥60 years old (OR=5.434, 95% CI:2.734～10.801), duration of disease (OR=1.046, 95% CI:1.013～1.080), body mass index (BMI) (OR=0.746,95% CI:0.622～0.840),ADL level (OR=0.618, 95% CI: 0.444～0.858) were independently correlated with osteoporosis in patients with hemiplegia. Conclusion Patients with hemiplegia in the stage of rehabilitation were at a high risk of osteoporosis. Aged over 60 years old, lower BMI, longer duration of disease and ADL level were independent risk factors for osteoporosis, which called for supervision and prophylaxis on osteoporosis.

ObjectiveTo study effects of oral administering alfa calcidol and diphosphonates on the bone mineral density (BMD) of patients with spinal cord injury (SCI).MethodsChanges of BMD of the 4th lumbar spine (L4), the proximal femur (total) and all of its subareas were studied between SCI cases of taking (n=31) and not taking (n=42) alfa calcidol. Changes of BMD between cases of taking diphosphonates (n=22) and not taking (n=24) were also compared.ResultsThere were no significant differences in BMD of L4, the proximal femur and all of its subareas between SCI cases of taking and not taking alfa calcidol. While there was a significant difference in BMD of the proximal femur (total) between cases of taking and not taking diphosphonates (P<0.05), and the reducing degree of BMD in the former is less than that in the latter.Conclusion Oral administering diphosphonates has a protective effect on SCI patients' BMD of the proximal femur.

Objective To investigate the changes of bone mineral density (BMD) and bone mass and the influencing factors in patients with hemiplegia.Methods The total BMD, bone mass, lean mass and fat mass of 366 patients (313 stroke cases and 53 TBI cases) with hemiplegia were tested by dual-energy X-ray absorptiometry, as well as the clinical features of all patients, were studied.Results The bone masses in the paretic side (upper limb, lower limb and trunk) decreased significantly compared with nonparetic side ( P<0.01); the differences of bone masses (%) in upper limb, lower limb and trunk between paretic and nonparetic side decreased with duration of disease or trauma ( P<0.01). The multivariable stepwise regression analyses showed that the total bone mass and total BMD were negatively correlated with age and duration of disease significantly (all P<0.01), and positively correlated with body mass index (BMI) significantly ( P<0.01), the total BMD was also positively correlated with lean mass ( P<0.01) and ADL level ( P<0.05).Conclusion The bone mass deceases in the paretic side significantly, and gets worse with the duration of disease. Age, duration of disease or trauma and BMI influence total BMD and bone mass; in addition, total BMD is correlated with total lean mass and ADL level.

Objective To evaluate the spontaneous closure of isolated fetal ventricular septal defect (VSD) in uterus and follow-up during the first year after birth using echocardiography. Methods From January 2012 to June 2017, 51 cases with isolated VSD without chromosome abnormality were observed in uterus and followed-up during the first year after birth using echocardiography in People's Hospital of Daxing District in Beijing City. The location, size, closure time of the VSD were recorded. The closure rate was calculated. The closure rate of the VSD in utero and in infant during the first year after birth were compared by Fisher exact probability method. The relation of closure rate and location and size were also analyzed (P＜0.05 was significant). The comparison between groups one by one were performed by Fisher exact probability method (P＜0.0167 was significant). Results In 51cases, 30 had perimembranous VSD, 16 with muscular VSD and 5 with infundibular VSD. In 20 closure cases (39.2%), 9 fetuses (17.6%) were closed in utero, 11 infants (21.6%) were closed during the first year after birth. There was no significant difference between the closure rate of the VSD in utero and the closure rate of VSD in infant during the first year after birth (P=0.804). In 16 with muscular VSD, 11 cases (68.8%) were closed, in whom 4 fetuses (25.0%) were closed in utero and 7 infants (43.8%) were closed during the first year after birth. In 30 perimembranous VSD, 9 cases (30.0%) were closed, in whom 5 fetuses (16.7%) were closed in utero and 4 infants (13.3%) were closed during the first year after birth. The closure rate of muscular VSD were significant higher than that of the closure rate of perimembranous VSD and infundibular VSD (P=0.007, 0.012). There were no significant difference between the closure rate of the perimembranous VSD and infundibular VSD (P=0.297). The infundibular VSD remained unclosed in all cases. In 35 cases with VSD≤3.0 mm, 19 cases (54.3%) were closed, in whom 9 fetuses (25.7%) were closed in utero and 10 infants (28.6%) were closed during the first year after birth. There was 1 closure case (7.6%) with VSD of 3.1-5.0 mm. The closure rate of VSD≤3.0 mm were significant higher than that of the VSD of 3.1-5.0 mm and the VSD＞5.0 mm (P=0.007, 0.013). There was no significant difference between the closure rate of the VSD of 3.1-5.0 mm and VSD＞5.0 mm (P=1.0). The VSD＞5.0 mm remained unclosed in all cases. Conclusions Isolated VSD has a high closure rate in utero and during the first year after birth. Echocardiography was a reliable method in diagnosis and follow-up of isolated VSD.

Objective To investigate and analyze surgical nurses' knowledge of nursing care for preventing venous thromboembolism (VTE) in 2015 and 2017 by this multicenter study. Methods Surgical nurses from 29 provinces and municipalities in China were investigated with the VTE prevention knowledge questionnaire designed for clinical nurses on the annual conference of the Chinese Nursing Association respectively from June to August 2015 and from October to December 2017. The results of these two investigations were compared. Results Totally 2 285 surgical nurses were investigated in 2017, whose average score was (50.97±11.529); while a total of 2 656 surgical nurses were investigated in 2015, whose average score was [(46.89±11.453), (t=7.568, P＜ 0.01)]. The scoring rate for physical and drug prophylaxis was lower than 60% in both investigations. Conclusions Surgical nurses show a higher level of VTE knowledge in 2017 than in 2015, but their mastery of such knowledge is still imbalanced. Hospital managers should pursue new training models and continue to popularize VTE-related knowledge in order to enhance VTE-related knowledge in surgical nurses and improve the quality of clinical nursing care.

Objective To investigate the protective effect and molecular mechanism of bloodletting acupuncture at Jing-well points on acute high-altitude hypoxia brain injury through regulating PI3K/AKT/mTOR signaling pathway-mediated mitochondrial autophagy,and to provide an effective target and theoretical basis for the clinical use of bloodletting acupuncture at Jing-well points to prevent and treat acute high-altitude hypoxia brain injury.Methods Male SD rats were randomly divided into Control group(n=15)and experimental group,and the experimental group was divided into Model group(n=15),Bloodletting Acupuncture at Jing-well Points of hand group(BAJP group,n=15),Bloodletting Acupuncture at Non-Acupoint group(BANA group,n=15).The low pressure oxygen chamber was depressurized to 6000 m altitude,and the rats in each experimental group were treated with low-pressure hypoxia for 72 h to replicate the acute high-altitude hypoxia brain injury rat model.The rats in the BAJP group were bled according to the order of"Shaoshang"(LU11),"Shangyang"(LI1),"Zhongchong"(PC9),"Guanchong"(SJ1),"Shaochong"(HT9),"Shaoze"(SI1),once a day for 7 days.The rats in the BANA group were bled by cutting the tail tip daily,and the amount of blood bled was 15-20 μL in both groups.The expression levels of PI3K,AKT and mTOR in hippocampal tissues of rats were detected by Western blot;AKT and mTOR mRNA expression levels in hippocampal tissues of rats were detected by PCR.Results Compared with the Control group,the number of degenerative necrotic vertebral cells in CA1 area of hippocampal tissue,swelling of mitochondria,appearance of autophagosomes,and increase of apoptosis in hippocampal tissue of Acute High-altitude Hypoxia(AHH)rats were significantly increased;After bloodletting acupuncture at Jing-well points of hand treatment,various brain injury manifestations in AHH rats were alleviated;Bloodletting acupuncture at non-acupoint had no significant ameliorating effect on AHH rats′ brain injury.Western blot detected a significant decrease in the phosphorylation levels of PI3K,AKT,and mTOR in the hippocampal tissues of AHH rats compared to Control group rats(P<0.01),and the phosphorylation levels of the three molecules were further decreased after bloodletting acupuncture at Jing-well points of hand treatment(P<0.01),and bloodletting acupuncture at non-acupoint treatment did not have significantly affect on the phosphorylation levels of these molecules(P>0.05),and AKT,mTOR mRNA expression levels further demonstrated the above trend.Conclusion Bloodletting acupuncture at Jing-well points of hand can play a protective role against acute high-altitude hypoxia brain injury with points specificity,and the mechanism may be related to the inhibition of PI3K/AKT/mTOR pathway to promote the elevated level of mitochondrial autophagy,improve mitochondrial physiology,and enhance the body′s ability to resist apoptosis and hypoxia.

Humans ; Child ; SARS-CoV-2 ; Viral Load ; COVID-19 ; Parents