Objective To compare the effects of limited fluid resuscitation and aggressive fluid resuscitation in treatment of uncontrolled hemorrhagic traumatic shock,and to improve the cure rate.Methods One hundred and twenty patients with hemorrhagic traumatic shock on the basis of outpatient registration number of single and double were divided into limited fluid resuscitation group(limited group,56 cases) and aggressive fluid resuscitation group (positive group,64 cases),respectively.The preoperative blood lactic acid,base excess,prothrombin time,hemoglobin was compared and the preoperative infusion and the number of patients with death was recorded.Results The preoperative infusion in limited group was significantly less than that in positive group [(1 050 ± 212) ml vs.(2 120 ± 186) ml],the difference was statistically significant (P ＜ 0.01).The mortality rate in limited group was significantly lower than that in positive group [12.50％(7/56) vs.28.12％(18/64)],the difference was statistically significant (P＜ 0.05).The preoperative blood lactic acid,base excess,prothrombin time in limited group were significantly lower than those in positive group [(3.31 ± 0.29) mmol/L vs.(5.78 ± 0.15) mmol/L,(5.42 ± 1.13) mmol/L vs.(9.86 ± 1.21) mmol/L,(11.7 ± 1.9) s vs.(18.1 ± 1.7) s],and the hemoglobin in limited group was significantly higher than that in positive group [(96 ± 18) g/L vs.(83 ± 20) g/L],the differences were statistically significant (P ＜0.01).Conclusions If hemorrhage is not controlled,early limited fluid resuscitation can maintain blood perfusion of vital organs,alleviate acidosis,reduce mortality and creat good conditions for advanced treatment.Limited fluid resuscitation is superior to aggressive fluid resuscitation in operative intervention for patients with uncomtrolled hemorrhagic traumatic shock.

Objective To evaluate the application value of focused assessment with sonography for trauma (FAST) in treatment of emergency thoracic and abdominal closed injury.Methods FAST examination was performed in 85 patients with thoracic and abdominal closed injury,to determine whether the thoracic and abdominal cavity,pericardial free effusion and abdominal parenchyma organ injury,and the results were compared with conventional ultrasonography,CT scan and operation results.Results FAST was (2.85 ± 1.15) min,conventional ultrasonography was (15.48 ±5.17) min,there was statistically significant difference (t =21.99,P ＜ 0.05).In 85 patients,10 cases were FAST positive,5 cases of abdominal cavity in that amount or a large number of free effusion,underwent emergency operation,postoperative intra abdominal parenchymal organs were confirmed as rupture and hemoperitoneum; 2 cases of renal rupture with perirenal hematoma,confirmed by the whole abdominal CT examination; 2 cases of thoracic free pneumatosis,effusion,confirmed by thoracic CT examination or closed thoracic drainage; 1 case of prompt hemopericardium,confirmed by the pericardium puncture.Conventional ultrasonography was positive in 11 patients,no statistically significant difference between them (P ＞ 0.05).The sensitivity,specificity,accuracy rate of FAST screening thoracic and abdominal closed injury was 10/12,100.0％ (73/73),97.6％ (83/85).Conclusions FAST has high sensitivity and specificity for thoracic and abdominal cavity,pericardial free effusion,check with short time,low environmental requirements,without moving the trauma patients,and may be out of sync with the fluid resuscitation and other emergency measures.For large quantities of trauma patients and patients with severe multiple trauma,FAST can quickly,accurately determine the existence of thoracic and abdominal closed injury,and provide guidance for clinical treatment,which has good application value.

Objective To summarize the experience of nursing achalasia of cardia patients after peroral endoscopicmyotomy ( POEM ) . Method Eighty-five achalasia of cardia patients were cared with careful preoperative preparation , active operational cooperation and postoperative psychological care , pain care , dietary instruction , complication treatment and discharge education . Results All patients went through POEM successfully even with severe complications. In the follow-up for 1~24 months, their dysphagia were alleviated and their weights increased by 1~30 kg. Conclusion Careful preoperative assessment and digestive tract preparation before operation and postoperative close observation, dietary education and nursing of complications are key for the successful POEM.

Objective:To investigate whether miR-548b-3p can regulate the malignant biological traits of hepatocellular carcinoma cells by down-regulating the expression of decoy receptor 3( DcR3). Methods:The miR-548b-3p levels in 5 common hepatoma cell lines Hep3b, HepG2, Huh7.5.1, PLC and 97H were detected by real-time fluorescence quantitative PCR. The experimental hepatoma cell lines were purchased from Shanghai Cancer Institute. The subcutaneous tumor formation experiment in nude mice included two parts: miR-548b-3p over expression group and down expression group. miR-548b-3p over expression experiment included Huh7.5.1- miR-548b-3p cell group and Huh7.5.1-NC cell group. The experimental group with low expression of miR-548b-3p included PLC- miR-548b-3p-sponge group and PLC-NC cell group, with 5 nude mice in each group. The nude mice used in the experiment were male Balb/c strain, body weight 20-25 g, 4-6 weeks old. Starbase software was used to predict whether there were binding sites between miR-548b-3p and DcR3. Dual luciferase reporting assay to verify whether DcR3 is the target gene of miR-548b-3p. Rescue experiments were conducted to verify whether the effects of miR-548b-3p on the proliferation, invasion and migration of liver cancer cells were realized through DcR3. Statistical analysis was performed using Graphpad Prism 9. Measurement data with normal distribution were expressed as mean±standard deviation( ± s), and t-test was adopted for comparison between general measurement data groups. Results:The relative expression level of 2 -ΔΔCt was used as the parameter for real-time fluorescence quantitative PCR comparison. Hep3b expression level was 1, HepG2 expression level was 0.902, Huh7.5.1 expression level was 0.712, PLC expression level was 1.293, and 97H expression level was 0.818. The final results showed that, The highest expression of miR-548b-3p was in PLC cells, and the lowest expression was in Huh7.5.1 cells. The subcutaneous tumor formation experiment of nude mice showed that after 4 weeks, the tumor volume of Huh7.5.1- miR-548b-3p was(444.77±142.34) mm 3, and that of Huh7.5.1-NC was(918.80±139.21) mm 3. The tumor volume of PLC- miR-548b-3p-sponge was(407.49±58.50) mm 3, and that of PLC-NC was(218.62±47.55) mm 3. The binding sites of miR-548b-3p and DcR3 were predicted by Starbase software. Dual luciferase assay showed that DcR3 was the target gene of miR-548b-3p. Rescue experiments verified that the effects of miR-548b-3p on the proliferation, invasion and migration of liver cancer cells were realized through DcR3. Conclusion:miR-548b-3p can regulate the proliferation, invasion, migration and other malignant biological traits of liver cancer cells, and it is achieved by down-regulating the expression level of DcR3.

Objective:To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods:The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results:The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min ( P>0.05). However, there were statistically significant differences ( P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation ( P>0.05). There were no statistically significant differences in surgical complication rates ( P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups ( P>0.05). Conclusions:Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.

Objective: To understand trends and related factors influencing overweight and obesity among primary and secondary school students in Tianjin, so as to provide a basis for formulating overweight and obesity prevention and control strategies. Methods: In September of each year from 2019 to 2023, a survey was conducted among 197 707 primary and secondary school students in 16 districts of Tianjin through a stratified random cluster sampling method. Physical examination was carried out in accordance with the Technical Standard for Physical examination for Student, and overweight and obesity survey was carried out. Basic information, smoking, drinking, diet, physical exercise, and sleep status were collected through questionnaire surveys. Results: The detection rates of overweight and obesity among primary and secondary school students in Tianjin from 2019 to 2023 were 39.07%, 43.33%, 41.54%, 43.92%, and 40.24%, respectively，showing an increasing trend(χ2trend=7.96,P<0.01). The detection rates of overweight increased in both vocational high schools and suburban counties (χ2trends=9.08, 47.18, P<0.01). The detection rates of obesity increased among both male and female students, in primary and vocational high schools and suburban counties (χ2trends=108.34, 15.99, 7.32, 10.95, 14.75, P<0.01). Multivariate Logistic regression analysis showed that smoking, drinking, unhealthful diet, and lack of proper physical exercise had a higher risk of obesity among primary and secondary school students (OR=1.26, 1.13, 1.08, 1.21, P<0.05). Stratified analysis showed that the risk of obesity was higher among boys with unhealthful and moderate lifestyle habits, as well as primary school students with unhealthful lifestyle habits (OR=1.15, 1.11, 1.27, P<0.05). Boys, girls and primary school students with unhealthful lifestyle habits, girls and ordinary high school students with moderate lifestyle habits had higher risk of being overweight (OR=1.14, 1.32, 1.21, 1.18, 1.40, P<0.05). Conclusions The detection rates of overweight and obesity among primary and secondary school students in Tianjin shows an increasing trend. Comprehensive lifestyle should be implemented to better prevent and control the risk of overweight and obesity.