Objective To study the changes of serum endotheline(ET),D-dimer and fibrinogen(Fbg) in infants with pneumonia complicated with heart failure(HF) and explore the changes of blood coagulation,fibrinolysis,and endothelial cell function.Methods Eighty patients with infant pneumonia complicated with HF and 20 controls were studied.Serum ET,D-dimer,Fbg,activated partial thromboplastin time(APTT),prothrombin time(PT) and thrombin time(TT) were measured.Results ET,D-dimer,Fbg,APTT in every group had differences.With the disease deteriorating,the values of ET,D-dimer,Fbg increased,but the values of APTT decresed gradually.There were positive relations between ET and D-dimer(r=0.42 P

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Critical Care ; methods ; Diuresis ; physiology ; Female ; Fluid Therapy ; methods ; Humans ; Injury Severity Score ; Intensive Care Units ; Male ; Middle Aged ; Multiple Trauma ; diagnosis ; mortality ; therapy ; Predictive Value of Tests ; Probability ; Prognosis ; Retrospective Studies ; Risk Assessment ; Shock, Hemorrhagic ; diagnosis ; mortality ; therapy ; Survival Rate ; Water-Electrolyte Balance

Objective: To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi. Methods: The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications. Results: All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ²=29.569, P<0.05) and position (χ²=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013). Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.

To develop a quality control checklist for the prevention and control of coronavirus disease 2019 （COVID-19） in fever clinic and isolation ward of the general hospital and to assess its application. Based on the relevant prevention and control plans and technical guidelines for COVID-19，Delphi method was used to identity items for evaluation，and a quality control checklist for the prevention and control of COVID-19 in the fever clinic and isolation ward was developed in Sir Run Run Shaw Hospital. The checklists included 8 dimensions and 32 items for fever clinic，7 dimensions and 27 items for the isolation ward. The appointed inspectors conducted daily quality control for each shift with this checklist. The expert authority coefficient was 0.88，the mean of the importance of each index in the quality control table was not less than 4.8，and the coefficient of variation was not more than 0.07. During the entire February 2020，8 problems were found and rectified on-the-spot with the application of the checklist. Quality inspection rate was 100% in both isolation wards and fever clinic. The compliance rate and accuracy rate of hand hygiene were 100%; the correct rate of wearing and removing protective equipment increased from 96% to 100%. During the same period，a total of 1915 patients were admitted to the fever clinic，including 191 suspected patients （all were isolated in the hospital，3 were confirmed）. There were no medical staff infected with COVID-19，no cross infection of patients and their families in the hospital. A quality control checklist for the prevention and control of COVID-19 has been developed and applied in the isolation wards and fever clinic，which plays an important role in preventing nosocomial infection.
COVID-19 ; Checklist ; Fever ; Hospitals, General ; Humans ; SARS-CoV-2

OBJECTIVETo investigate the clinical effect of laparoscopic radical resection of colon cancer.

METHODSPatients with colon cancer who underwent radical resection during January 2000 to January 2004 in Sir Run Run Shaw Hospital (Medical College of Zhejiang University) were divided into open and laparoscopic groups for a non-randomized case-control study. All the patients were followed up and their clinical and pathological results were compared.

RESULTSNo difference was seen between the two groups on the patients' age, gender, lymph node numbers and Dukes staging. The laparoscopic group had a longer mean operation time [(182 +/- 62) min vs (141 +/- 37) min] and shorter hospital stay [(5.3 +/- 1.9) d vs (8.2 +/- 1.2) d] than the open group. All surgical margins were pathological negative. Post-operation follow up was 12-18 months (mean 21 months). No incision recurrence was found in neither group. As far the local recurrence and distal metastasis rate were similar in both groups.

CONCLUSIONSLaparoscopic radical resection of colon cancer has minimal invasion and shorter recuperation than open procedure, the radicalness and either local recurrence or distal metastasis rate after surgery are similar when compared with open group.

Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colectomy ; methods ; Colonic Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Treatment Outcome

Aged ; Carcinoma, Renal Cell ; pathology ; secondary ; Duodenal Neoplasms ; secondary ; surgery ; Female ; Humans ; Kidney Neoplasms ; pathology ; Nephrectomy

Adult ; Enchondromatosis ; pathology ; Female ; Granulosa Cell Tumor ; pathology ; Humans ; Ovarian Neoplasms ; pathology

Objective To observe the therapeutic effect of Lai's acupuncture therapy combined with Chinese herbal decoction for the treatment of infertility with ovulatory dysfunction, and to summarize the experience of Professor Lai Xin-Sheng in treating infertility. Methods Ninety-six infertility patients with ovulatory dysfunction were randomized into treatment group and control group, 48 cases in each group. The treatment group was treated with Lai's Tongyuan acupuncture therapy for regulating Governor Vessel to tranquilize mind, inducing meridian Qi to original Qi, and was also given oral use of Chinese herbal decoction of Lai's Yiyun Recipe for promoting gestation. The control group was treated with Chinese herbal decoction alone. The treatment began exactly after the completion of menstruation period and lasted 15 days for one treatment course, covering 3 courses. And then the patients of the two groups were followed-up for 3 months. Therapeutic effect and pregnancy rate were evaluated after treatment, serum levels of estradiol and progesterone were examined, and abdominal ultrasonography was used for monitoring the maximum diameter of the dominant follicles and endometrial thickness before and after treatment. Results (1) Three cases from the treatment group and 5 cases from the control group were dropped out, and the final case number in the treatment group and control group was 45, 43 respectively. (2) The total efficiency of the treatment group was 88.9％, and that of the control group was 81.4％. The effect of the treatment group was better than that of the control group (P < 0.05). (3) The pregnancy rate of the treatment group was 73.3％, higher than that of the control group (51.2％), the difference being significant (P < 0.05). (4) After treatment, the maximum diameter of the dominant follicles and endometrial thickness in the two groups were obviously improved(P < 0.05 compared with those before treatment), and the improvement in the treatment group was superior to that in the control group (P < 0.05). (5) After treatment, the serum levels of estradiol and progesterone in the two groups were obviously improved(P < 0.05 compared with those before treatment) , and the improvement in the treatment group was superior to that in the control group(P < 0.05). Conclusion The therapeutic effect of Lai's acupuncture therapy combined with Chinese herbal decoction is superior to that of Chinese herbal decoction alone, showing an obvious synergistic effect by shortening the course of treatment and enhancing pregnancy rate.

Objective To evaluate the safety and efficacy of flexible ureteroscopy lithotripsy (FURL) for the treatment of renal stone in solitary kidney patients.Methods The clinical data of 46 patients of solitary kidney,who were treated with FURL from March 2015 to May 2018 in our hospital,were analyzed retrospectively.There were 34 males and 12 females,aged (48.6 ± 9.6) years.Maximum diameter of stone was (15.3 ±4.8) mm,and 29 cases in left kidney and 17 cases in right.34 cases were non-renal calcaneal calculi,12 cases were subrenal calyceal stones.There were 3 cases of congenital solitary kidney,31 cases of functional solitary kidney (contralateral kidney GFR ＜ 10 ml/min) and 12 cases of acquired solitary kidney (7 cases of renal calculi,4 cases of tumor,1 case of tuberculosis).The mean reoperative serum creatinine was (116.38 ± 25.77)μmol/L.All patients were treated with general anesthesia,lithotomy,soft ureteroscopy combined with holmium laser lithotripsy,and assisted lithotripsy.All operations were performed by the same surgeon.The data of operation time,hospital stay,blood loss,renal function before and after operation,postoperative complications and stone clearance rate were recorded.Results In this study,46 cases of the operation were successfully completed.The mean operation time was (58.6 ±16.4) min,the average hospitalization time was (5.6 ± 1.4) days.The mean hemoglobin was decreased (1.4 ± 0.9) g/L.The mean operative time was (58.6 ± 16.4) min.The average postoperative hospitalization time was (5.6 ± 1.4) days.The Postoperative hematuria occurred in 32 cases,low back pain in 3 cases and fever in I case.Stone-free reached in 39 of 46 patients,the stone-free rate(SFR)of primary operation was 84.8％ (39/46).There were 7 cases of residual calculi,five patients were treated with secondary FURL,2 patients were required conservative treatment.The SFR was 95.7％ (44/46) after the second stage operation.The mean serum creatinine was (112.29 ± 20.62) μ mol/L on the first day after operation,which was not different statistically with that before operation (P =0.177).The mean serum creatinine was (81.54 ± 10.75) μmol/L one month after operation,which was significantly lower than preoperative and 1 day postoperative (P ＜ 0.05).Conclusions FURL could be a safe and effective treatment for renal stone in solitary kidney patients.It has a definite stone-free effect,low incidence of complications.

OBJECTIVETo investigate viral relapse and the associated risk factors during a long-term follow-up study of chronic hepatitis C (CHC) patients who achieved end-of-treatment response (ETR) after interferon and ribavirin therapy.

METHODSThis retrospective study was conducted on 146 CHC patients treated with a combination of ribavirin and pegylated (PEG) interferon-alpha (IFNa) (n=126) or conventional IFNa (n=20) for 24 (hepatitis C virus (HCV) non-genotype 1b) or 48 (HCV genotype 1b) weeks. The main outcome measure was serum HCV RNA load. The risk factors analyzed included age, sex, HCV genotype, baseline HCV RNA load, and IFN type.

RESULTSThe mean follow-up time for all patients was 33.45+/-16.41 months (range: 12-85 months). The cumulative relapse rate during follow-up was 14.80%. The relapse rate within six months (8.90%) was significantly higher than other periods during two years of follow-up, and no relapse occurred after 30 months. Of all relapsers (n=20), 65% occurred within six months, followed by 35% within 7-24 months after antiviral therapy. The relapse rates in patients with HCV genotype 1b and non-1b were not significantly different (20.37% vs. 12.12%, X2 =1.517, P=0.315). The mean baseline HCV RNA load was significantly higher in the relapsers than that in the non-relapsers (t=0.915, P=0.362). Relapse rates were similar in patients treated with PEG-IFNa-2b, PEG-IFNa-2a and IFNa (12.12% vs. 13.97% vs. 15.00%, respectively; X2=0.104, p=0.949). The mean age of relapsers was significantly higher than that of non-relapsers (P less than 0.005).

CONCLUSIONThe maximum probability of relapse for CHC patients exists within six months from when ETR is achieved by interferon and ribavirin therapy. A lower risk for relapse persists past this period. Thus, ETR CHC patients, especially older patients, should be carefully monitored during the two years after cessation of antiviral therapy. Standard antiviral therapy based on HCV genotype eliminates the influence of viral factors on treatment-response.

Adolescent ; Adult ; Aged ; Antiviral Agents ; therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic ; drug therapy ; pathology ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Middle Aged ; Polyethylene Glycols ; therapeutic use ; RNA, Viral ; Recurrence ; Retrospective Studies ; Ribavirin ; therapeutic use ; Treatment Outcome ; Young Adult