The early screening and early diagnosis of biliary atresia is the key to improve the 5-year native liver survival rate,jaundice-free-native-liver survival rate and overall survival rate.So far,the neonatal jaundice,especially that caused by surgical cholestasis exists the lack of awareness.Because of this reason,the delay depletion jaundice patients did not receive early diagnosis and treatment until the severe complications happened.So,it has often missed the best period of operation for the biliary atresia.Called for local medical health governments to formulate the effective early screening methods of biliary atresia and the reasonable schedule of postnatal follow-up,and improving the ability of basic unit medical staff in well understanding cholestasis disease in order to achieve early diagnosis and treatment.Consequently,it will improve the situation of diagnosis and treatment of biliary atresia in our country.

Objective To investigate the therapeutic effect on allergic rhinitis(AR)with plasma radiofrequency breaking to the ethmoidal nerve and ablating concha nasalis inferior under endoscope.Methods 98 cases with AR were included in this study,which were randomly divided into 2 groups.The treating group was treated with plasma radiofrequency breaking to the ethmoidal nerve and ablating concha nasalis inferior under endoscope,the control group was treated with microwave.Results The total and significantly effective rates were 94% and 78% in the treating group,68.8% and 39.6% in the control group.The therapeutic effect of the treating group were obviously higher than that in the control group(P＜0.01).Conclusion The therapy of plasma radiofrequency breaking to the ethmoidal nerve and ablating concha nasalis inferior in the AR treatment under endoscope had the advantage of little bleeding,no serious adverse effect and com plication,significantly effective and fine clinical application.

Objective Through observation of the expression and activity of extracellular regulated protein kinase 5 (ERK5) and its relationship with the learning and memory ability in rats with chronic fluorosis,to further study the pathogenesis of chronic fluorosis in nervous system.Methods Thirty SD rats were divided into 3 groups according to body weight by means of a random number table (10 rats in each group,half male and half female).The rats in control group were fed with free drinking tap water containing less than 0.5 mg/L fluoride (NaF);the rats in low fluoride group with 10.0 mg/L fluoride;the rat in high dose fluoride group with 50.0 mg/L fluoride.After 6months of experiment,rat brain tissue was took,mRNA expression level of ERK5 was detected by real-time fluorescence quantitative PCR (real-time PCR),protein expression level and activity of ERK5 were detected by Western blotting;the learning and memory ability of rats with chronic fluorosis were detected by Morris water maze test.Results The rat in groups exposed to fluoride exhibited different degrees of dental fluorosis and the fluoride content in urine of rats increased gradually with increase of fluoride doses (F =164.10,P ＜ 0.05).The protein levels of phosphor-ERK5 in the control group,low fluoride group and high fluoride group were 0.13 ± 0.03,0.29 ± 0.10and 0.43 ±0.17,respectively,the difference was statistically significant (F=11.96,P＜ 0.05),and low fluoride group and high fluoride group were higher than control group (all P ＜ 0.05).The total protein levels of ERK5 in control group,low fluoride group and high fluoride group were 0.32 ± 0.11,0.37 ± 0.13 and 0.49 ± 0.16,respectively,the difference was statistically significant (F =3.45,P ＜ 0.05),and high fluoride group was higher than control group (P ＜ 0.05).The expression of ERK5 mRNA in rat brains between groups was not significantly different (F =0.81,P ＞ 0.05).The second,third,and forth days of directional navigation experiment,the time of escape latency and the number of crossing the platform between groups were statistically significant (H =28.20,29.90,26.47,27.23,35.34,27.62,all P ＜ 0.01);the fifth day of space exploration experiment,the difference of the time of the first crossing platform and the number of crossing the platform between groups were statistically significant (H =31.41,30.80,all P ＜ 0.01);the protein level of phosphor-ERK5 in brain tissue of rats was negatively correlated with the number of the first crossing platform (r =-0.470,P ＜ 0.01),while positively related to escape latencies at the fifth day of the test (r =0.591,P ＜ 0.01).Conclusion The changes of ERK5 signaling pathway in rat brain tissue caused by chronic fluorosis are found,which are related to the decrease of leaming and memory ability of animals with chronic fluorosis.

Objective To evaluate covered stent placement in the treatment of iliac artery rupture in the process of iliac artery angioplasty.Methods Clinical data of 9 patients' iliac artery rupture in the process of iliac artery angioplasty were retrospectively reviewed.Results Covered stent was successfully placed in all cases.The patency of involved iliac artery was identified in 8 cases by angiography and there was no contrast extravasation.Type Ⅰ endoleak occurred in one patient in the proximal end of the stent graft and iliac artery graft replacement was done by open surgery immediately.Postoperatively clinical symptoms were relieved in all these 9 patients.One case lost to follow up.8 patients were followed up for 14 to 45 months,average (22 ±9) months.Stenosis on the distal end of the covered stent (external iliac artery)was found in one patient who underwent external iliac artery balloon-expandable stent angioplasty.One patient with artificial vessel placement was symptoms free with patency of the involved artery as reviewed by ultrasonography on 18 month followed up.Conclusions When iliac artery rupture in the process of iliac artery angioplasty should develop,the first choice is immediately covered stent placement therapy,while open surgery remains as the last resort.

Objective To study the regulatory effect of hydrogen sulfide (H2S) on endoplasmic reticulum stress in alveolar epithelial cells of rats with acute lung injury (ALI) induced by oleic acid (OA).Methods Seventy-two male Sprague Dawley (SD) rats were equally divided into control group (C group),oleic acid-induced ALI group (OA group),oleic acid-induced ALI with sodium hydrosulfide (NaHS) pretreatment group (OA + NaHS group) and sodium hydrosulfide treatment group (NaHS group).The model of acute lung injury was made by oleic acid intravenous injection in dose of 0.1 mL/kg.NaHS was injected intra-abdominally in dose of 1 ml/kg with concentration of 56 μmol/L 30 min before administration of oleic acid for pretreatment.In control groups,saline was used instead of oleic acid and NaHS in the equivalent volume.Six rats of each group were sacrificed at 2 h,4 h and 6 hours separately after modeling for observing the acute injury of lung tissue.Index of quantitative assessment of histological lung injury (IQA),wet/dry weight ratio (W/D) and H2S level of lung tissues were measured.The endoplasmic reticulum stress markers included glucose-regulated protein 78 (GRP78) and α-subunit of eukaryotic translation initiation factor-2 (elF2α) in lung tissues were measured by immunohistochemical staining and Western blot.Results At the three observation intervals,the IQA score and W/D ratio of lung tissues significantly increased in rats-after OA injected,but significantly decreased in other rats receiving both OA and NaHS.At the three intervals,the level of H2S in lung tissue significantly decreased in rats after OA injected,but significantly increased in other rats receiving both OA and NaHS.GRP78 and elF2α decreased in rats after OA injected,but increased in other rats receiving both OA and NaHS especially at 4 h and 6 h after modeling.Conclusions The findings suggested that H2S could promote the response to alveolar epithelial cell endoplasmic reticulum stress in rats with ALI resulting in attenuating the damage of lung tissue caused by oleic acid.

Objective:To investigate reflectance confocal microscopic features of childhood scabies, and to analyze clinical significance of reflectance confocal microscopy (RCM) in the diagnosis and treatment of childhood scabies.Methods:A retrospective analysis was performed in 77 children with confirmed scabies at Department of Dermatology, Tianjin Children′s Hospital from April 2018 to October 2019. These patients were divided into negative treatment history group (61 cases) and positive treatment history group (16 cases) . All the patients underwent RCM and microscopic examination of skin scrapings.Results:Among the 77 children with scabies, positive microscopic examination results were found in 33 (42.86%) , including 28 in the negative treatment history group and 5 in the positive treatment history group. Burrows, sarcoptid mites or their eggs and fecal pellets were observed in 56 cases (72.73%) by RCM, including 49 (80.33%) in the negative treatment history group and 7 in the positive treatment history group. RCM showed a significantly increased overall positive rate compared with microscopy of skin scrapings ( χ2=14.08, P<0.05) . In the negative treatment history group, RCM also showed a significantly increased positive rate compared with microscopy of skin scrapings ( χ2=15.53, P < 0.05) . Conclusion:RCM is of high clinical value to the diagnosis and treatment of childhood scabies.

Objective To explore the effect of conservative treatment for Stanford B aortic intramural hematoma without calcified plaque and the midterm follow-ups.Methods Clinical data of 20 patients with Stanford B aortic intramural hematoma without calcified plaque which were confirmed by CTA of the whole aorta were retrospectively analyzed.There were 12 males and 8 females,with the age of 35～ 52 years.All of them received pharmacotherapy and psychotherapy.Results All the 20 cases were asymptomatic after conservative medical treatment when they discharged,and were followed up whit imaging tests.They all lived without symptoms during the follow-up period.The pleural fluid on the left side was disappeared in 11 cases after 3 months and the aortic intramural hematoma was absorbed in 13 cases after 6 months.After 1 year there were total 18 cases without aortic intramural hematoma,while The thickness and scope of the hematoma were reduced significantly in the other 2 cases.Conclusion It' s ease to find whether the patient with Stanford B aortic intramural hematoma got calcified plaque or not; the conservative treatment for Stanford B aortic intramural hematoma without calcified plaque has satisfactory clinical effect in midterm follow-ups.

Objective To investigate the suitable therapeutic schedule for Stanford B aortic intramural hematoma associated with calcification. Methods During the period from March 2009 to March 2012, a total of 15 patients of Stanford B aortic intramural hematoma with calcified plaque were admitted to authors’ hospital. The diagnosis was proved in all patients by CT angiography of the entire aorta with a 64-row CT scanner. Of the 15 patients, death occurred in one, thoracic endovascular aortic repair (TEVAR) treatment was adopted in 7 and conservative therapy was carried out in 7. All the patients were followed up for one year. CT angiography was employed at 3, 6 and 12 months after the treatment to evaluate the therapeutic results. Results One patient died of acute myocardial infarction after admission to hospital when the long-tem use of antiplatelet drugs was stopped. Seven patients received TEVAR treatment and the remaining 7 patients were treated with strict conservative therapy, and all these patients were asymptomatic at the time of discharge. During the follow- up period, CT angiography performed at 3, 6 and 12 months after the treatment showed that the intramural hematoma lesions gradually shrank or were absorbed in 13 patients, and the patients were asymptomatic. The remaining one patient was lost in touch. Conclusion The key to treat Stanford B aortic intramural hematoma with calcification is to prevent deterioration of the lesion. While strict conservative treatment is kept on, TEVAR should be promptly carried out for patients who need to take antiplatelet drugs over a long period of time, for patients whose clinical symptoms are not improved, for patients in whom the relived symptoms recur, and for patients whose CT angiography shows that the penetrating aortic ulcer becomes worse.

Objective To investigate the feature of fracture in elderly patients in Beijing Jishuitan Hospital from 2009 to 2016.Methods The data of elderly patients with fracture visiting the department of trauma emergency in Beijing Jishuitan Hospital from 2009 to 2016 were retrospectively reviewed.The data of patient number,age,gender,seasonal and circadian variation of visit and fracture site were collected and analyzed.Results Among all the 42 988 elderly patients with fractures visiting department of trauma emergency from 2009 to 2016,there were more female patients than male patients (P ＜ 0.01).In both male and female patient groups,there was a trend of increase in number of patients year by year (P ＜ 0.01).Elderly patients in the groups of 60-69 years,70-79 years and 80-89 years demonstrated a trend of increasing number from year to year notably in the 60-69 years group (P ＜ 0.01) but the total number of patients decreased as age increased.As for seasonal variation,autumn had the highest number of cases and spring the lowest (P ＜ 0.01).Most elderly patients visited emergency during 8:00-16:00 period (P ＜ 0.01).The commonest sites of fractures were at radius and femur.Conclusions Fracture of elderly patients has its unique feature in gender,age,seasonal and circadian variation of visit and fracture sites.The community should do a better planning for prevention and management of elderly patients with fractures according to their specially clinical features.

Objective To evaluate interventional therapy in the treatment of interposition graft stenosis or occlusion after mesocaval shunts.Methods The clinical data of 19 cases of artificial vessel stenosis or occlusion after mesocaval shunts for portal hypertension at our department from march 2009 to march 2012 were retrospectively analyzed.Results In the 19 cases with artificial vessels stenosis or occlusion developed after mesocaval interposition shunts for portal hypertension,there were 5 cases in which acute thrombosis occurred within a week after the surgery.Catheter directed thrombolysis was successfully conducted.In 6 cases in which shunt stenosis developing 1 to 8 years after surgery were managed by balloon dilatation or stent angioplasty successfully.The shunt graft occlusion occurred in 8 cases after 1 to 4 years of surgery was successfully managed and the shunt was reopened by balloon dilatation or stent angioplasty in 6 cases,and in 2 the procedure was failed for the guide wire can't go through the anastomotic site of artificial vessel-superior mesenteric vein.In 11 cases embolization of the esophagogastric varices was successfully carried out for postoperative standard anticoagulation.During a period of 3 months to 3 years follow-up,stenosis recurred 1 year after balloon dilatation in one case,and stenosis was managed by angioplasty successfully.Conclusions Interventional radiological techniques by percutaneous puncture through femoral vein-inferior vena cava-artificial vessel-portal vein (including catheter directed thrombolysis,balloon dilatation,stent placement,etc) are less traumatic,highly successful in the treatment of shunt stenosis or occlusion after mesocaval shunts in portal hypertension.