Objective Mycoplasma pneumoniae is one of the main pathogens of community-acquired pneumonia in children and teenagers , which may cause mycoplasma pneumoniae pneumonia ( MPP) .Atelectasis is one of the most common manifestations of MPP.The aim of the article was to evaluate the diagnostic and therapeutic value of fiberoptic bronchoscopy ( FB) in children with MPP associated with atelectasis . Methods Retrospective analysis were made on clinical data and FB records of 99 cases of hospitalized children with MPP associated with atelectasis from August 2010 to December 2012 . Results The positive rate of MP-DNA was 92.9%(92/99) in bronchoalveolar lavage fluid (BALF), and the positive rate of MP-Ab-IgM in serum was 68.7%(68/99).All pa-tients showed obviously bronchial mucosa congestive edema during FB examination .The results are as follows:bronchial phlegm bloc-king in 31 cases (31.3%), lumen inflammatory stenosis in 22 cases (22.2%),mucosal ulcer change in 7 cases(7.1%) and mucous nodular change in 3 cases (3.0%).4 weeks after being treated with bronchoalveolar lavage (BAL), only 3 cases remained in atelec-tasis, the partial and complete re-expansion rate reaching 96.5%(82 of 85). Conclusion The positive rate of BALF MP-DNA de-tection technology for the diagnosis of MP infection is higher than that of serum MP-Ab-IgM examination .Early interventional therapy by FB can shorten the course of disease and promote the lung re-expansion in children with MPP associated with atelectasis .

Objective To study the correlation between lactate/albumin ratio level and incidence of multiple organ dysfunction syndrome (MODS) as well as mortality in patients with severe sepsis or septic shock.Methods In January 2012-September 2013, 54 patients who were admitted to the intensive care unit(ICU) of a hospital developed severe sepsis and septic shock on the first day of admission, clinical data of patients were analyzed.Results On the first and second days of admission, 30(55.56%)and 26(53.06%)patients developed MODS;lactate/albumin ratio between MODS group and non-MODS group on the first and second days of admission were both significantly different (both P<0.05).Multivariate logistic regression analysis showed that lactate/albumin ratio, oxygenation index (PaO2/FiO2), as well as acute physiology and chronic health evaluation (APACHE Ⅱ) were independent risk factors for predicting MODS in patients with severe sepsis.Lactate/albumin ratios between MODS group and non-MODS group, death group and non-death group were both significantly different (both P<0.05);lactate/albumin ratio was correlated with APACHE Ⅱand PaO2/FiO2, the higher the APACHE Ⅱ score and the lower the PaO2/FiO2, the higher of lactate/albumin ratio.The area under the receiver operating curve (ROC curve) analysis showed that incidence and mortality of MODS on the first day of admission predicted by lactate /albumin ratio were 0.85 and 0.84 respectively;sensitivity, specificity, positive predictive value, and negative predictive value of occurrence of MODS predicted by lactate /albumin ratio>1.735 were 80.00%, 79.17%, 82.67%, and 75.92% respectively, sensitivity, specificity, positive predictive value, and negative predictive value of mortality were 100.00%, 51.02%, 17.23%, and 100.00% respectively.Conclusion Lactate/albumin ratio level is closely correlated with incidence and mortality of MODS in patients with severe sepsis or septic shock.

Objective To investigate changes in tracheal bronchus (TB) under bronchoscopy and its clinical features in children.Methods The bronchoscopy datum,clinical manifestations and treatments of 46 children with TB from Department of Respiratory Medicine,Anhui Provincial Children's Hospital,were retrospectively analyzed.Results Among 46 cases,31 patients had displaced TB,13 patients had supernumerary TB,and 2 patients had trachea diverticulum.Meanwhile,in 45 cases was located at the right tracheal wall and 1 case was located at the posterior tracheal wall.Besides,20 cases were found accompanied with one type of tracheo bronchial anomalies,and the other 3 patients had 2 types of anomalies.Luminal stenosis,mucous membrane longitudinal fold and/or mucous plug were mostly revealed by bronchoscopy.Clinically,the main symptom s included recurrent or persistent cough,wheezing,refractory pneumonia,atelectasis or hyperinflation in the right upper lobe.Some cases showed no symptoms and were found accidentally by using chest CT or bronchoscope to check other diseases.Through anti-inflammatory and bronchoalveolar lavage (BAL) treatment,symptoms were improved or disappeared in 38 cases,the efficient rate was 82.6％.Conclusions TB is not unusual in pediatric patients,and mainly be found at the right wall of the trachea.Displaced TB is the most common type and frequently accompanied with the other anomalies.TB should be considered when recurrent or persistent cough,wheezing,or refractory pneumonia,atelectasis or hyperinflation in the right upper lobe occurred.Bronchoscopic technology is an important tool in the diagnosis and treatment of children with TB and may be used widely in pediatric diseases clinically.

Objective To analyze the correlation between herpes zoster neuralgia and the methylation status of the whole genome and GCH1 gene.Methods From June to October in 2017,patients with confirmed herpes zoster and obvious neuralgia were selected in Department of Dermatology,The Affiliated Hospital of Xuzhou Medical University,who achieved complete remission (no effect was observed on normal sleep) of neuralgia after antiviral and neurotrophic treatment.Finally,36 patients and 36 healthy controls were enrolled into this study.Peripheral blood samples were obtained from the healthy controls and patients before and after the treatment.Dot-blot hybridization assay was performed to determine the methylation status of the whole genome,methylated-DNA IP kit was used to enrich the methylation sites of the GCH1 gene,and real-time quantitative PCR was conducted to detect changes in methylation status of the GCH1 gene.Statistical analysis was carried out with GraphPad Prism v7.00 software by using paired t test for the comparison of methylation status before and after the treatment,and two-sample t test for the comparison between the patient group and control group.Results The relative methylation level of the whole genome was 135.94 ± 2.52 in the patients before treatment,significantly lower than that in the patients after treatment (144.76 ± 3.48,t =2.056,P ＜ 0.05) and healthy control group (146.84 ± 3.39,t =2.580,P ＜ 0.05).However,there was no significant difference in the methylation status of the whole genome between the patients after treatment and healthy controls (t =0.429,P ＞ 0.05).Compared with the patients after treatment (0.89 ± 0.13) and healthy control group (0.97 ± 0.07),the methylation status of the GCH1 gene significantly decreased in the patients before treatment (0.65 ± 0.17;t =3.977,4.648 respectively,P ＜ 0.05,＜ 0.01 respectively),while no significant difference between the patients after treatment and the healthy controls (t =0.506,P ＞ 0.05).Conclusion The methylation status of the whole genome and GCH 1 gene markedly decreased in the patients with herpes zoster neuralgia.

Guanosine triphosphate cyclohydrolase 1 (GTPCH1) is a protein encoded by the GCH1 gene,which catalyze GTP to tetrahydrofolinine (BH4) under physiological condition.BH4 is a coenzyme of aromatic amino acid hydroxylase and a cofactor of nitric oxide synthases.BH4 involves in the synthesis of various hormones and neurotransmitters and plays an important role in a series of pathophysiological processes in vivo.Recent studies showed that GTPCH1 is involved in the pathogenesis of neuropathic pain,doparesponsive dystonia,cancer and cardiovascular diseases.In this review,we will discuss the role of GTPCH1 in those diseases mentioned above.

Objective To investigate the efficacy and safety of exsanguination band used in the lower extremity varicose vein operation.Methods A total of 158 cases of lower extremities varicose veins in this hospital served as the research subjects.All cases underwent the high ligation of great saphenous vein combined with punctate stripping operation.Among them,117 cases intraoperatively used the exsanguination band for blocking the lower limb blood flow (observation group),41 cases did not use the exsanguination band (control group).Then the intraoperative bleeding volume,operation time,pain degree and postoperative complications were observed in the two groups.Results Compared with the control group,the operation time,intraoperative blood loss,hematoma score,prothrombin time (PT) and fibrinogen (FIB) in the observation group were significantly decreased (P＜0.05),while activated partial thrombin time (APTT) and thrombin time (TT) were significantly increased(P＜0.05).The lower limb blood flow occlusion time in the observation group was 45-62 min with an average of (46.68-5.53) min.The sensory score and pain score at postoperative 2 weeks had no statistical difference between the two groups (P＞0.05).No arterial abnormalities and no obvious ischemic injury were found in the injured limbs of 2 groups.Conclusion Applying the exsanguination band for transiently blocking the blood flow can effectively shorten the operation time,reduces the intraoperative bleeding amount and decreases the subcutaneous hematoma formation risk with high safety.

Objective To evaluate the efficacy and safety of fluorouracil and leucovorin and oxaliplatin(FOLFOX)regimen hepatic artery infusion chemotherapy(HAIC)combined with lenvatinib(LEN)and immune checkpoint inhibitors(ICIs)in treating patients with hepatocellular carcinoma(HCC)after the occurrence of transcatheter arterial chemoembolization(TACE)refractoriness.Methods The clinical data of 54 HCC patients who developed TACE refractoriness,were admitted to the Jiangsu Provincial Cancer Hospital of China to receive FOLFOX-HAIC combined with LEN and ICIs therapy between January 2019 and December 2022,were retrospectively analyzed.The modified Response Evaluation Criteria in Solid Tumors(mRECIST)was used to statistically analyze the clinical efficacy,the Common Terminology Criteria For Adverse Events version 5.0(CTCAE 5.0)was adopted to record and evaluate the treatment-related adverse events(TRAEs).The primary endpoints were progression-free survival(PFS)and overall survival(OS),the secondary endpoints were objective response rate(ORR),disease control rate(DCR),and safety.Results The median PFS was 11.7 months(95％CI:8.124-15.276 months),the median OS was 23.1 months(95％CI:19.508-26.692 months),the ORR was 46.3％,and the DCR was 87.0％.The most common TRAE at all levels was elevated alanine aminotransferase(51.9％),and the most common TRAE of grade 3/4 was hypertension(9.3％).No treatment-related death occurred.Conclusion For the treatment of HCC patients who developed TACE refractoriness,FOLFOX-HAIC combined LEN and ICIs is clinically safe and effective.(J Intervent Radiol,2024,33:610-615)

Objective To investigate independent risk factors for unintended initial dissection of the posterior plane(UIDPP)during small incision lenticule extraction(SMILE)by surgeons with different qualifications.Methods A total of 1 600 patients(3 003 eyes)who underwent SMILE performed by three surgeons with different qualifications from April to September 2021 were selected as the research subjects,including 911 males and 689 females,with an average age of(21.82±3.55)years.The incidence of UIDPP in patients was recorded,along with a comprehensive summary of the age,gender,eyes,surgeons,surgical proficiency,subjective refraction,central corneal thickness,lenticule thickness,side cut angle,and peripheral lenticule thickness of the patients.Independent risk factors of UIDPP were analyzed using the binary logistic regression.Test level:α=0.05.Results In this study,the incidence of UIDPP was 6.56％(197/3 003),and the lenticule was successfully removed in all eyes.Multivariate logistic regression analysis demonstrated that surgeon(P=0.035),surgical proficiency(P=0.026),eyes(P=0.007),lenticule thickness(P＜0.001),and peripheral lenticule thick-ness(P＜0.001)were independent risk factors associated with the UIDPP during SMILE surgery.No significant differences were observed in other parameters(all P＞0.05).Conclusion Surgeons,surgical proficiency,eyes,lenticule thick-ness,and peripheral lenticule thickness are independent risk factors of UIDPP.

In order to adapt to the development of market economy, the original medical institutions run by state-owned enterprises have undergone restructuring reform, but these medical institutions have not fully played their role. Through the sampling survey and research interviews of several medical institutions run by state-owned enterprises, it was found that many problems such as unclear functional positioning, imperfect regional health planning, unclear responsible subjects and inadequate financial support hindered the development of medical institutions run by state-owned enterprises. In order to develop healthily, medical institutions run by state-owned enterprises need to cooperate with various parties to improve supporting policies, optimize their business environment, and build and improve the health service system.

Objective:To investigate the effectiveness and safety of transurethral low power green laser enucleation of prostate (VREP) after transrectal prostate puncture.Methods:The clinical data of 96 patients with VERP in the First Affiliated Hospital of Xinxiang Medical College from October 2020 to October 2021 were retrospectively analyzed. They were randomly divided into the control group ( n=41) and the observation group ( n=55). The control group did not undergo prostate biopsy before operation, and the observation group underwent transrectal prostate biopsy within 1 week before operation. The general data, perioperative indexes, maximum urinary flow rate ( Qmax), international prostate symptom score (IPSS), quality of life score (QOL) and complications of the two groups were compared before and 3, 6 and 12 months after surgery. Results:Preoperatively, the PSA was higher in the observation group compared with the control group ( P<0.05), and the differences in other general information were not statistically significant (all P>0.05). Compared with the control group, the observation group had longer operation times and heavier resected specimens, and the differences were statistically significant (all P<0.05), but there were no statistically significant differences between the two groups in the comparison of enucleation efficiency, crushing efficiency, postoperative hemoglobin (HGB) decline value, postoperative hospitalization time, and postoperative ureter removal time (all P>0.05). At 3, 6 and 12 months postoperatively, Qmax, IPSS and QOL were significantly improved in the observation group compared with the control group (all P<0.05). However, there was no statistically significant difference between the two groups in the comparison of the above-mentioned indexes in the same period after surgery (all P>0.05). There was no statistically significant difference in the complication rate comparison between the two groups ( P>0.05). Conclusions:Transurethral low-power green laser prostate enucleation after transrectal prostate puncture is efficacious and has a certain degree of safety.