Objective To study the incidence of malposition of catheter at different body positions during the operation of peripherally inserted central catheter (PICC),and then select the optimum position to increase the success rate of insertion. Methods 155 patients were randomly divided into the horizontal position group (55 cases),the semi-reclining position group (49 cases) and the sitting position group (51cases).They all used chest X-ray to conffirm the position of top end of the catheter after insertion and then comparing the incidence rate of malposition of catheter among three groups. Results After insertion,11 patients' catheters were found malposition.Among them,8 patients were in the semi-reclining position group (incidence rate 16.3％),2 patients were in the horizontal position group (incidence rate 3.6％) and only one patient was in the sitting position group (incidence rate 1.9％ ).Incidence rate of catheter malposition in the semi-reclining position group was significantly higher than other two groups. Conclusions The best position for PICC is the horizontal position.If the patient has expiratory dyspnea or need to adjust the malposition catheter,sitting position can be used.Semi-reclining position should be avoided in the operation of PICC.

[Objective] To investigate the effects of airway dysbacteriosis on the development of murine atlergic airway diseases (AAD).[Methods] Female C57BL/6 mice were neubulized with Vancomycin for 10 days and then were sacrificed.The bacterial population in bronchoalveolar lavage fluid (BALF) were evaluated using 16S rRNA high-throughput sequencing technology,exploriug the method of establishing an airway dysbacteriosis mouse model.After the mouse model was established successfully,airway dysbacteriosis mouse models were established by the same method,and based on that,the mice were sensitized and challenged with ovalbumin (OVA) to induce airway allergic inflammation.The frequency of nasal rubbing behaviors per mice was counted;the total cell number and eosinophil relative abundance in BALF were evaluated;the lung tissue inflammation and goblet cell metaplasia were assessed according to histopathological features;and the IgE level in serum,IFN-γ,IL-4 and IL-5 levels in BALF,and IL-33 levels in serum,BALF and intestine tissue were measured by ELISA.[Results] Nebulization of Vancomycin increased Bradyrhizobium,Sphingopyxis,Cupriavidus,Pelomonas,and decreased Akkermansia and Prevotella_6 in airway,inducing significant airway dysbacteriosis.Using the animal model,further study found that airway dysbacteriosis exacerbated OVA-induced airway allergic inflammation,including increased nasal rubbing frequency,higher serun IgE level,more total cell count especially eosinophil infiltration,more serious lung tissue inflammation and goblet cell metaplasia.Additionally,compared to OVA group,mice in Dysbacteriosis and OVA group had significantly increased level of Th2 cytokine IL-4 and IL-5,and significantly decreased Thl cytokine IFN-γin BALF,which revealed that mice in Dysbacteriosis and OVA group had mote remarkable Thl/Th2 imbalance.Furthermore,IL-33 level showed a significant increase in BALF,but didn't change in serum or intestine tissue in Dysbacteriosis and OVA group compared to OVA group.Indicating that airway dysbacteriosis may only affect the local production of IL-33.[Conclusions] An airway dysbacteriosis mouse model was established by Vancomycin nebulization successfully.Airway dysbacteriosis may activate innate lymphoid cells (ILC) and Th2 cell by inducing local IL-33 secreting,which leads to the imbalance of Th1/Th2,and in turn promotes the development of AAD.

Objective To investigate the diagnosis and therapy of primary maligmant tumors of the heart. Methods Clinical data of 21 patients with malignant cardiac tumors admitted to our department from June 1980 to May 2008 was analyzed and the references were reviewed. Results All patients received operations. Pathological classification of the tumors was made by histological examinations. Radical resections for 10 eases and partial resections for 5 eases were performed. The other 6 patients received only thoracotomy and cardiac exploration. Three eases were lost during follow up. Three survivors received radical resections are still alive now 2-15 months after the surgery, while all the other patients died within 4 years after the operation due to malignant tumor recurrence and (or) metastasis. Conclusion Echocardiography, CT, 3D-CT, MRI, coronary CT and angiocardiography are helpful for the diagnosis of the malignant cardiac tumors and the selection of operations. Histological examination is necessary for the final diagnosis. Early diagnosis, radical resection and post-operative radiotherapy and chemo therapy may provide a better result.

Objective To investigate the method and effectiveness of the digital artery series and parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger Methods Between September 2008 and July 2012,the finger artery series retrograde island flaps tiled in the repair of finger degloving injury in 13 cases,repair of adjacent finger tip degloving injury in 11 cases; 8 cases of degloved injuries of the fingertip were tiled with the digital artery parallel island flap from ulnaris middle finger and radialis ring finger of arteria digitalis communis pedicled which were from the same palm side.The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm-7.2 cm ×5.5 cm,gutted flap minimum ranged from 1.1 cm × 1.0cm-1.5 cm × 1.3cm,and the maximum ranged from 3.0 cm × 2.2 cm-5.5 cm × 4.5 cm.The donor sites were repaired with the intermediate split thickness free skin grafts and performed with pressure dressing.Results The group of 32 cases,in 1 case the flap vasospasm occurred in operation of free process,the symptoms disappeared after local application of papaverine and hot compress ; 1 case of flap occurred disturbance of blood circulation after operation because of tight suturing for pedicle,the symptoms relieved after removing the stitches at intervals; 2 cases blisters appeared after operation,disappeared after a week.All skin flaps were survived,incision and skin graft donor sites healed by first intention.Twenty patients were followed-up from 6 to 12 months after operation.All flaps presented the satisfactory appearance and texture,recovered protective feeling.At last follow-up,the two-point discrimination was 7 to 10mm,and the flexion and extension function of wounded fingers recovered to normal.According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association,there were excellent in 19 cases,good in 10 cases,and moderate in 3 cases.No significant loss to the donor shape and function.Conclusion The surgery by adopted the digital artery series or parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger,not only has the advantages of simpleness,safety and reliability,but also can satisfy the patients who aren't willing to accept or because of physical reasons can't accept the treatment of abdominal skin tube or nail flap from hallux toe,which performs in both high-end and low level hospitals,and deserves of general application.

Objective To comparatively analyze the immunological characteristics of patients with mild and severe influenza A (H1N1), and to provide the evidence for condition monitoring and treatment . Methods 52 cases with mild influenza A ( H1N1), 152 cases with severe influenza A ( H1N1) and 26 healthy subjects from July 1, 2009 to December 31, 2009 were enrolled in the study.Lymphocyte subsets in peripheral blood were analyzed by flow cytometry and the serum concentrations of interferon -γ( IFN-γ) and interleukin-4 (IL-4) were detected by enzyme-linked immune-sorbent assay (ELISA).Results The total lymphocyte counts were decreased obviously in patients with severe influenza A ( H1N1) than in mild pa-tients and in healthy subjects (P<0.01).The T lymphocyte, NK cells, CD4+T lymphocyte and CD8+T lym-phocyte were also decreased obviously in severe patients than in mild patients (P<0.01).The B lymphocyte and CD4+/CD8+were also decreased in severe patients than in mild patients but had no significant statistical difference (P=0.11, 0.175).The serum IFN-γlevels in patients with mild and severe influenza A (H1N1) were lower than those in control group, especially in patients with severe influenza A (H1N1) (compared with control group and mild group , P<0.01).And the changes of serum IL-4 levels were the same with the former, but there were no statistically significant differences in three groups (P>0.05).Con-clusion Immune dysfunction in patients with influenza A (H1N1) infection is associated with the severity of disease, especially cellular immunity .Therefore, monitoring of the immune system is valuable for the diag-nosis of influenza A(H1N1) infection.

Objective:To investigate the factors affecting the therapeutic effects of stereotactic radiotherapy on primary liver cancer.Methods:The clinical data of 116 patients with primary liver cancer who received stereotactic radiotherapy in Binzhou Central Hospital from February 2018 to April 2020 were retrospectively analyzed. The factors that affect the therapeutic effects of stereotactic radiotherapy on primary liver cancer were analyzed.Results:Stereotactic radiotherapy was effective in 85 patients, with an overall response rate of 73.28%. There were no significant differences in maximum tumor diameter, arteriovenous fistula, portal vein tumor thrombus, distant metastasis, pseudocapsule, liver function Child-Pugh grade, Barcelona clinic liver cancer staging, and the number of stereotactic radiotherapies between different patients ( χ2 = 14.71, 12.76, 19.16, 8.54, 7.30, 7.71, 9.41, 4.08, P < 0.05 or < 0.01). Maximum tumor diameter, portal vein tumor thrombus, pseudocapsule, liver function Child-Pugh grade, Barcelona clinic liver cancer staging, and the number of stereotactic radiotherapies were the independent risk factors that affect the therapeutic effects of stereotactic radiotherapy on primary liver cancer (Wald χ2 = 3.13, 3.75, 4.16, 5.20, 3.90, 3.40, all P < 0.05). Conclusion:Many factors affect the therapeutic effects of stereotactic radiotherapy on primary liver cancer. Early identification of the high-risk factors for primary liver cancer is conducive to minimizing the risk of stereotactic radiotherapy, improving the therapeutic effects of stereotactic radiotherapy, and improving the prognosis. This study is highly innovative and scientific.

OBJECTIVETo evaluate the clinical value of prophylactic radiotherapy for esophageal carcinoma after curative operation.

METHODS495 esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery alone group (S, 275) and a surgery plus radiotherapy group (S + R, 220). Radiation treatment was started 3 - 4 weeks after operation. The portals encompassed the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50 approximately 60 Gy in 20 approximately 30 fractions over 5 approximately 6 weeks was delivered.

RESULTS1. Survival rate: the overall 5-year survival rate was 39.4%. Those of S alone and S + R groups were 37.1% and 41.3% (P = 0.447 4). The 5-year survival rate for Stage III patients were 13.1% in S alone group and 35.1% in R + S group (P = 0.002 7), 2. Pattern of failure: The incidence of local recurrence intra-thoracic lymph node metastasis, anastomotic recurrence and extra-thoracic lymph node metastasis in S + R group (16.2%, 0.5% and 3.1%) were lower than those (25.9%, 5.8% and 13.2%) (P < 0.05) in S alone group and 3.

COMPLICATIONSthe anastomotic stricture frequencies were similar in the two groups (S 1.8%; S + R 4.1%).

CONCLUSION1. Prophylactic radiotherapy is able to improve the survival rate of stage III patients treated by radical resection, 2. Postoperative radiotherapy is able to reduce the incidence of failure by recurrence in the intra-thoracic lymph nodes and anastomotic recurrence to where radiation therapy had been given, 3. Postoperative radiotherapy does not increase the incidence of anastomotic stricture.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; radiotherapy ; secondary ; surgery ; Combined Modality Therapy ; Esophageal Neoplasms ; mortality ; pathology ; radiotherapy ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Postoperative Care ; Survival Rate

Objective To evaluate the effect of Levosimendan on the prognosis in patients with severe coronary heart disease after operation.Methods A total of 485 severe coronary disease patients undergoing coronary artery bypass grafting from Teda International Cardiovascular Hospital and the Cardiac Surgery Department of the First Affiliated Hospital of China Medical University from May 2014 to June 2016 were enrolled.Of them,45 cases receiving Levosimendan postoperatively were assigned to the Levosimendan group,and according to propensity score matching,another 45 cases were selected as the control group in this study.Clinical data before treatment had no difference between the groups (P ＞ 0.1).Postoperative prognosis was compared between the two groups.Results There were significant differences in heart rate,mean arterial pressure,central venous pressure,cardiac output and other hemodynamic parameters between the two groups 48h after operation.The heart ultrasound results showed that the left ventricular ejection fraction(IVEF) was increased [(0.53±0.12) ％vs.(0.46±0.09)％,t =2.594,P=0.002],the postoperative ventilation time was reduced [(46.8±11.3) h vs.(58.5±16.3) h,t=-2.031,P=0.045]and the onset of bowel sounds became early [(16.5±5.9) h vs.(18.7±10.1) h,t =1.592,P=0.039]in the levosimendan group than in the control group 48h after operation.The incidences of new-onset acute kidney injury(20 ％ and 40 ％,x2 =6.702,P =0.018),new-onset postoperative atrial fibrillation (15.6％ and 44.4％,x2 =6.156,P =0.023) and perioperative myocardial infarction(11.1 ％ and 33.3％,x2 =6.429,P =0.021) had significant differences between the two groups(P＜0.05),but there was no difference in ICU retention time,1-month mortality after operation,malignant arrhythmia incidence and auxiliary equipment use (P ＞ 0.05).Conclusions Levosimendan can improve the early prognosis of severe coronary disease patients undergoing coronary artery bypass grafting and reduce the occurrence of postoperative organ dysfunction.

Objective: To observe the changes of retinal microstructure in lamellar macular hole (LMH) after vitrectomy. Methods: A retrospective clinical observational study. Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People’s Hospital from January 2014 to September 2018 were included in this study. Among them, 14 patients (15 eyes) were males and 26 patients (26 eyes) were females, with an average age of 67.8±8.6 years. There were 37 eyes with a lens and 4 eyes with an IOL. There were 29 eyes with LMH of tractional type, 7 eyes of degenerative type, and 5 eyes of mixed type. All patients underwent BCVA and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The average logMAR BCVA was 0.57±0.27; the mean macular retinal thickness (CRT) was 192.3±108.9 μm, the mean macular thickness (MRT) was 427.5±110.2 μm. Among the 29 eyes of tractional type, there were 17 eyes with retinal cavity, 8 eyes with macular retinoschisis, and 3 eyes with incomplete ellipsoid zone. Among the 7 eyes of degenerative type, there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP), 5 eyes with retinal cavity, and 5 eyes with incomplete ellipsoid zone. Among the 5 eyes of mixed type, 2 eyes with LHEP, 1 eye with macular epiretinal membrane, and 4 eyes with incomplete ellipsoid zone. The average follow-up time after surgery was 12.8±5.2 months. Among them, 10 eyes were followed up for equal or greater than 24 months. After the surgery, the same equipment and method before the surgery were used for relevant examination. The changes of BCVA, CRT, and MRT before and after surgery were observed. Continuous variables were compared by t test. Results: At the last follow-up, the mean logMAR BCVA was 0.37±0.26. Compared with before surgery, the difference was statistically significant (t=5.98, P<0.01). The mean CRT and MRT were (245.2±90.8) and (347.0±46.7) μm, respectively. Compared with before surgery, the differences were statistically significant (t=-2.49, -5.24; P<0.05, <0.01). CRT and MRT changed greatly within 6 months after surgery, and then tended to be gentle. Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery, ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye. Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery, there were still 4 eyes with retinal cavity, but all the retinoschisis were disappeared. Among the 5 eyes with retinal cavity of degenerative type before surgery, there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone. Among 10 eyes with a follow-up time of equal or greater than 24 months, the macular ganglion cell complex partially atrophied in 6 eyes, and the nerve fiber layer separated in 2 eyes. There was no full-thickness macular hole after surgery. Conclusion For most LMH patients, vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure.

Objective:To investigate the risk factors for futile recanalization in patients with acute anterior circulation large vessel occlusion after endovascular mechanical thrombectomy (EMT), and establish a nomogram model predicting futile recanalization in these patients.Methods:One hundred and eighty-eight patients with acute anterior circulation large vessel occlusion after EMT were enrolled from Department of Neurology, Zhongshan Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine from January 2018 to December 2021. Patients were divided into futile recanalization group and effective recanalization group according to whether futile recanalization occurred; futile recanalization was defined as successful recanalization showed by immediate postoperative DSA (modified thrombolysis in cerebral infarction [mTICI] ≥2b), but poor functional outcome (modified Rankin Scale [mRS] scores>2 90 d after surgery). The clinical data were compared between futile recanalization group and effective recanalization group. Multivariate Logistic regression analysis was used to screen the risk factors for futile recanalization. R software was used to establish a nomogram model for futile recanalization. C-index was used to evaluate the differentiation of the model, and correction curve was used to evaluate the accuracy of the line graph model prediction. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficiency of the nomogram model.Results:Ninety-two patients had futile recanalization. Compared with the effective recanalization group, futile recanalization group had significantly older age, significantly higher hemoglobin A1c on admission, significantly longer time from puncture to vascular recanalization, significantly higher proportions of patients with hypertension history and poor collateral circulation, and significantly different severities of stroke and white matter hyperintensities (WMHs) and distribution of occlusive sites ( P<0.05). Multivariate Logistic regression analysis showed that age, history of hypertension, time from puncture to vascular recanalization, poor collateral circulation, severe WMHs, and moderate-severe stroke were independent risk factors for futile recanalization after EMT in patients with acute anterior circulation large vessel occlusion ( P<0.05). A nomogram model of futile recanalization was established according to the above 6 factors, with C-index of 0.862 ( 95%CI: 0.809-0.914); the calibration curve of the model was highly coordinated to the ideal model curve; area under the ROC curve of futile recanalization was 0.862 ( 95%CI: 0.809-0.914, P<0.001). Conclusions:Acute anterior circulation large vessel occlusion patients with older age, history of hypertension, longer time from puncture to vascular recanalization, poor collateral circulation, severe WMHs, and moderate-severe stroke trend to have futile recanalization after EMT. This nomogram can predict futile recanalization after EMT.