Objective To investigate the imaging features and differential diagnosis of obstructive jaundice caused from non-neoplastic diseases.Methods The retrospective descriptive study was conducted.The clinical data of 62 patients with obstructive jaundice caused from non-neoplastic diseases who were admitted to the Peking University People's Hospital between August 2014 and August 2016 were collected,including 13 with immunoglobulin G4 associated cholangitis (IAC),2 with primary sclerosing cholangitis (PSC),21 with recurrent purulent cholangitis (RPC),2 with Mirizzi syndrome,4 with groove pancreatitis (GP) and 20 with Lemmel syndrome.All the patients underwent plain and enhanced scans of computed tomnography (CT) and magnetic resonance imaging (MRI) and magnetic resonanced cholangio-pancreatography (MRCP).Film reading were respectively done by 2 imaging doctors,and then was analyzed again by senior doctors when there is disagreement.Observation indicators:(1) situations of imaging exanination and imaging features;(2) treatment and follow-up.Patients received laboratory and related examinations and then underwent corresponding treatment after diagnosis.Follow-up using outpatient examination and telephone interview was performed once every 6 months to detect patients' prognosis up to November 2016.Results (1) Situations of imaging examination and imaging features:of 62 patients,21 underwent plain and enhanced CT scans,7 underwent plain and enhanced MRI scans,4 underwent MRCP,15 underwent plain and enhanced CT scans and MRCP,1 underwent plain and enhanced CT scans and plain and enhanced MRI scans,3 underwent plain and enhanced MRI scans and MRCP and 11 underwent plain and enhanced CT scans,plain and enhanced MRI scans and MRCP.Imaging features of 13 patients with IAC:MRI scans showed that diffuse and symmetrical bile duct walls were thickened,with delayed enhancement.The narrowed lumen of bile duct was mainly occurred in common bile duct,without occlusion.Of 13 patients with IAC,9 were combined with IgG4 associated pancreatitis and 7 with bilateral nephropathy.Imaging features of 2 patients with PSC:MRI scans showed that bile duct wall was multiple localized thickening and persistent enhancement,that was imaging feature of liver cirrhosis.MRCP examination showed that intra-and extra-hepatic bile ducts had multifocality stricture and beading-like and/or dry twig-like dilatation,and branches of intrahepatic peripheral bile duct were reduced.Imaging features of 21 patients with RPC:MRI and CT scans and MRCP examination showed that there was thickening bile duct wall and delayed enhancement.The first and second level of intrahepatic bile duct were segmental dilatation,distal bile duct dramatically narrowed and branches of intrahepatic bile duct were reduced.Most of extrahepatic bile duct was dilatation and a few were narrow-like changes.There were stones of intrahepatic bile duct and pneumobilia.Liver parenchymal atrophy with cholangiectasis occurred most frequently in left lobe or right posterior lobe of liver.There were secondary liver abscess and cholangiocarcinoma.Imaging features of 2 patients with Mirizzi syndrome:MRI scans showed that there was common hepatic duct stricture caused by stones in the junction between neck of gallbladder and common hepatic duct,and intra-and extra-hepatic bile ducts dilatation in proximal end of stones and normal bile duct in distal end of stones.There were gallbladder and biliary fistulas,irregular gallbladder wall thickening and inflammation around the gallbladder.Imaging features of 4 patients with GP:MRI scans showed that no clear mass was detected in duodenal loop and head of pancreas,with heterogeneous and slightly irregular enhancement.Cyst formation occurred in intramural wall of duodenum and head of pancreas.Enhanced MRI scans showed that common bile duct wall was thickened and slightly irregular stricture,pancreatic duct was normal or mild expansion,and thickened duodenal wall had varying degrees of stenosis of lumen.Imaging features of 20 patients with Lemmel syndrome:MRI scans showed that pouch-like structure was detected inside of the descending duodenum,with thin cyst wall and liquid in cyst wall.MRCP examination showed dilatations of common bile duct and intra-and extra-hepatic bile ducts.(2) Treatment and follow-up:of all the 62 patients,30 underwent corresponding surgeries,including 2 with IAC,1 with PSC,7 with RPC,2 with Mirizzi syndrome,3 with GP and 15 with Lemmel syndrome,and the other 32 without surgery received corresponding medical treatment.Sixty of 62 patients were followed up for 3-17 months.During follow-up,28 patients undergoing surgery received definitive diagnosis and good recovery,2 were lost after definitive diagnosis and 32 undergoing medical treatment were in stable condition.Conclusion Non-neoplastic diseases can cause obstructive jaundice,with a higher misdiagnosis rate,imaging findings of which can be conducive to diagnose diseases and provide clinical treatment.

ObjectiveTo investigate the feasibility of apphcation of risk factors management in nursing of the fever outpatient.Methods145 patients from May to December 2009 admitted to fever clinic was defined as the control group, 157 patients from January to May 2010 admitted to fever clinic were set as the observation group. The control group was given routine nursing, while the observation group adopted risk factor management measures. The management indices of the two groups were compared.ResultsThe patients' recognition score of risk factors of fever clinic was (85.4 ± 2.7)in the observation group, higher than(73.2 ± 3.9)in the control group. Patients' satisfaction degree was 84.7％ in the observation group, higher than 67.6％ in the control group. Rate of risk event of the observation group was 1.3％, lower than 6.2％ in the control group, the incidence of nursing errors was 0.6％ in the observation group, lower than 4.1％ in the control group, rate of patients' complaints of nurses was 1.3％ in the observation group, lower than 5.5％ in the control group.ConclusionsThe implementation of risk factors management in fever clinics can reduce medical accidents, improve nursing quality, so this clinical management mode deserves promotion and application.

Objective To investigate the effect of nursing intervention on preventing leakage of urine in patients with indwelling catheter in neurology department.Methods A total of 76 patients with indwelling catheter in neurology department were randomly assigned into the observation group and the control group with 38 cases in each group.The control group received routine care,the observation group received systemic nursing intervention on the basis of routine care.The incidence of leakage of urine and patients satisfaction degree with nursing service was observed between two groups.Results The incidence of leakage of urine in the control group was 21.1％,higher than 2.6％ of the observation group.he score of satisfaction degree of the observation group was (4.66±0.62),higher than(3.26±0.42) of the control group.Conclusions Nursing intervention can effectively reduce the incidence of leakage of urine and improve the satisfaction degree of patients with indwelling catheter in neurology department,it is worthy of clinical application.

40 cm H 2O (1 cm H 2O=0.098 kPa) in 4.Among the 5 children without urinary complaints,2 had detrusor hyperreflexia,2 had detrusor-sphincter dyssynergia,and 1 was generally normal.Postoperatively the improvement of urinary incontinence rate was greater in patients with primary TCS (28.6%,8/28) than those with secondary TCS (0%,0/7;P=0.048). It was greater in patients with non-lipoma TCS (100%,3/3) than those with lipoma TCS ( 15.6%,5/32;P=0.004).It was greater in patients with meningocele TCS (36.4%,8/22) than those with myelomeningocele TCS(0%,0/6;P=0.047).It was greater in patients born without urological symptoms (80%,4/5) than those born with urological symptoms(17.4%,4/23;P=0.019).Urodynamic studies also showed the incidence of detrusor hyperreflexia after surgery was lower in primary TCS (24.2%,8/32) than in secondary TCS(71.4%,5/7;P=0.015);the incidence of detrusor underactivity was lower in non-lipoma TCS (12.5%,1/8) than in lipoma TCS(56.3%,18/32;P=0.027);decreased compliance rate was lower in meningocele TCS than in myelomeningocele TCS(100%,6/6;P=0.0052).The rates of detrusor hyperreflexia,decreased compliance and detrusor underactivity postoperatively were lower in those born without urinary symptoms (0,0/10;20%,2/10;20%,2/10) than in those with (34.89%,8/23;60.9%,14/23; 65.2%,15/23;P=0.032,P=0.031,P=0.017, respectively). Conclusions Urodynamic examinations are effective in evaluating the lower urinary tract function in children with TCS after surgery.Patients with TCS have various abnormal urodynamic findings.Pathological types of TCS and the presence of symptoms at birth influence urinary function after surgery.

Objective To study the relationship among the slow vertex response (SVR) ,tone burst ABR threshold and pure tone thresholds in young people with normal hearing ,and to discuss the values of SVR and tb -ABR assessing hearing thresholds .Methods A total of 30 normal-hearing young people aged 20 to 24 were indud-ed in this study .The thresholds of SVR ,tb -ABR and threshold of PTA were tested at each verbal frequency (0 .5 ,1 ,2 ,4 kHz) .The differences and the relationship among SVR with PTA ,tb-ABR ,and PTA were statistical-ly studied .Results The differences between SVR and tb -ABR and PTA at various frequencies were statistically significant (P<0 .05) .The minimum difference between SVR and PTA was (3 .59 ± 7 .32) dB at 0 .5 kHz .The differences of 1 ,2 ,and 4 kHz were 6 .92 ± 5 .07 ,8 .33 ± 6 .71 ,and 9 .83 ± 9 .41 dB ,respectively .The minimum differences between tb -ABR and PTA was 14 .58 ± 7 .24 dB at 4 kHz ,and the differences of 0 .5 ,1 ,and 2 kHz were 29 .42 ± 6 .83 ,23 .25 ± 7 .47 ,and 16 .50 ± 6 .43 dB ,respectively .SVR and PTA had a good correlation at 1 and 2 kHz (r=0 .51 ,P<0 .01 and r=0 .44 ,P<0 .05 ,respectively) .tb-ABR and PTA had a good correlation at 4 kHz (r=0 .53 ,P<0 .01) .Conclusion In normal hearing young population ,SVR and tb-ABR can estimate PTA well , and the former is closer to PTA threshold .

Objective To study the effect of H_2O_2 on the cultured melanocytes and the relationship between oxidative stress and vitiligo.Method Melanocytes were cultured with H_2O_2,the proliferation and melanogenesis of melanocyte were analysed by MTT and NaOH assay.Result H_2O_2 can inhibite the proliferation and melanogenesis of melanocytes,and the inhibition was concentration and-time-dependent.Conclusion Oxidative stress can inhibite the proliferation and melanogenesis of melanocytes,but oxidative damage can not induce vitiligo.

Abstract On October 13 2023, the Beijing Economic and Technological Development Area Center for Disease Control and Prevention recAAAAAeived a report from a school indicating an outbreak of fever among students in Class 2, Grade 4. An on-site epidemiological investigation was immediately conducted. A total of 14 cases were reported, all of whom were students, with an attack rate of 34.15%. The onset of illness was concentrated between October 6 and 15, with the main clinical symptoms being fever, cough and fatigue. There were no cases of hospitalization, severe illness or death. Seven cases tested positive for Mycoplasma pneumoniae P1-Ⅱ. Based on the on-site investigation and laboratory test results, it was an outbreak of influenza-like illness caused by Mycoplasma pneumoniae infection. The likely cause of the spread was cases infecting other classmates through respiratory droplets while attending class. The outbreak occurred only in one class and did not spread to neighboring classes. Schools should actively carry out health education to raise awareness among parents for reporting infectious diseases, and strengthen morning and afternoon screenings to improve the sensitivity of identification.

Objectivo To analyze urine organic acids in the urine using gas chromatography-mass spectrometry(GC/MS)for diagnosis of inherited metabolic diseases,especially for organic acids metabolic disorders.Methods 195 clinical urine samples from the patients with suspected organic acids metabolic disorders and 5 normal urine from adults were collected.After mixing some urine with intemal standards according to the concentration creatinine and adding hydroxylamine hydrochloride to mixture,the organic acids with hydroxyl group were oximated to the ketobodies.Organic acids were extracted twice with ethyl acetate and ethyl ether and derivatized with BSTFA-TMCS.An the organic acids were determined with Agilent GC/MS 6890/5973i with scan model.the mass-to-charge ratio range is 50-550 m/z,all data were nalyzed with Agilent GCMSD ChemStationG1701DA.We also investigated the linearity, accurate,precision.recovery and Carry-over by determining the internal standards in normal samples and positive organic acids in spiked control samples.Results More than one hundred kinds of organic acids in urine samples can be analyzed with this method.According to the two internal standards in normal urine samples,the minimal detection limit MMA and 2.PA was 2.5-2.8 μmol/L.Intra-and interassay coefficient of variation for MMA and 2-PA are both less than 10%.Pre-processing Interassay coefficient by sequential preparations of the same sample was 14%.The recoveries of the spiked samples were 95%-105%.Carryover analysis was less than 1%.All the parameters meet the requirement for clinical diagnosis.12 samples demonstrated positive including 6 cases of methylmalonic acidemia,1 case of propionic acidemia,3 cases of tyrosinemia Ⅰ,1 case of maple syrup urine disease and 1 cases of ketosis.Conclusions The method for the determination of organic acids in urine by GC/MS has been successfully established.It can be used for clinical screening and diagnosis for inherited genetic metabolic diseases.

Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring blood volume during one-lung ventilation in patients undergoing thoracoscopy operation. Methods Twenty-two ASA Ⅰ or Ⅱ patients ( 12 male, 10 female) aged 18-60 yr undergoing thoracoscopy operation under general anesthesia were studied. Anesthesia was induced with midazolam, sufentanil, propofol and rocuronium and maintained with TCI of propofol and remifentanil and intermittent iv boluses of vecoronium. Robertshow double-lumen endobronchial tube was inserted. Correct position of the tube was verified by fiberoptic bronchoscopy. The patients were mechani40 mm Hg. Radial artery was cannulated and connected to FloTrac pressure transducer and Vigileo monitor. A loading dose of 6% HES 5 ml/kg was infused over 10 min. MAP, HR, CO and SVV were recorded before and at 3 min after loading dose. The change rate of SVV (SVV) and CI (△CI) were calculated. Increase in CI by 11% was considered effective volume expansion. The ROC curve for SVV in determining the volume expansion efficacy was plotted. The area under the curve for SVV and 95% confidence interval were calculated. Results (1) CO were significantly increased while SVV decreased after a loading dose of HES. (2) During two-lung ventilation 12 patients responded to the 6% HES loading dose.SVV correlated with△CI ( - 0.710, P ＜ 0.05). The volume expansion efficacy was determined by SVV 11.5 % (sensitivity = 82 %, specificity = 92 % ). The area under the curve for SVV and 95% confidance interval were 0.880 (0.580-0.987). (3) During one-lung ventilation 11 patients responded to the 6 % HES loading dose. SVV correlated with CI ( - 0.668 , P ＜ 0.05). The volume expansion efficacy was determined by SVV 9.5 % ( sensitivity = 77 %, specificity = 63 % ). The area under the curve for SVV and 95% confidance interval were 0.971 (0.917-1.024). Conclusion One-lung ventilation does not alter the ability of SVV in monitoring blood volume in patients undergoing thoracoscopy operation.

Gastrointestinal neuroendocrine tumor(GI-NET)originates from peptide neurons and neu-roendocrine cells in gastrointestinal tract,and secrets peptide hormones,leading to carcinoid syndrome which rarely happens in clinical practice. Because of the improvement of diagnostic method and understanding of this rare disease,the morbidity is rising in recent years. The main treatments of GI-NET are surgery and compre-hensive therapy,consisting of chemotherapy and targeted therapy.