Objective To investigate the feasibility of retroperitoneoscopy in the treatment of adrenal masses in infants under 6 months old.Methods From January 2020 to November 2023,retroperitoneoscopic surgery was performed in 5 infants under 6 months old with adrenal tumors.Their age was from 1 month and 18 days to 4 months and 27 days,and their body weight was 5-8 kg.The lesion was found by prenatal ultrasonography in 1 case and by abdominal ultrasonography for other reasons after birth in 4 cases.Ultrasound and CT indicated a diameter of 1.7-5.5 cm for the adrenal masses.Results The operations of adrenalectomy and tumor resection were completed under retroperitoneoscopy.The operative time was 65-135 min(median,94 min).The intraoperative blood loss was less than 10 ml.The postoperative drainage tube retention time was 3-6 d(median,5 d).Pathological diagnosis showed 4 cases of adrenal neuroblastoma and 1 case of adrenal hyperplasia.Follow-ups for 1-36 months(median,3 months)with abdominal ultrasound and CT scanning showed no recurrence or metastasis.Conclusion Retroperitoneoscopy is relatively safe for the treatment of adrenal tumors in infants under 6 months old(tumors with acceptable boundaries).

Objective To summarize the clinical experience of thoracoscopic treatment of anterior mediastinal enterogenous cysts.Methods From July 2019 to July 2023,27 children diagnosed as having anterior mediastinal enterogenous cysts were treated with total thoracoscopic surgery through the lateral thoracic approach(three port method)in our department.The patients were placed in a healthy lateral position.The observation hole was located in the 5th intercostal space under the scapula,and the other 2 operating holes were established based on the location of the lesion and the endoscopic diamond-shaped method,both of which were 5 mm trocars.The CO2 pneumothorax was established at a pressure of 6 mm Hg.The visceral pleura of the cyst was opened with an electric hook,the cyst was fixed and pulled by intestinal forceps,and the cyst was completely removed by forceps and electric hook separation alternately.Results No conversion to thoracotomy was required.Complete resection was performed in 26 cases,and residual cyst wall existed in 1 case.Esophageal muscular layer was opened in 9 cases.During the operation,cysts obstructed the surgical field of view in 5 cases,which was not conducive to observation.The cyst puncture and fluid extraction were performed.The operation time was 45-120 min(median,70 min).The amount of blood loss was 3-10 ml(median,5 ml).Postoperative hospitalization lasted for 2-5 d(median,3d).The 27 cases were followed up for 1-43 months(median,22 months),and there was no recurrence.The compressed trachea in 2 cases was all recovered,with emphysema fully recovered.Conclusions Thoracoscopic treatment of anterior mediastinal enterogenous cysts in children is safe and feasible.When the surrounding structure of the lesion is complex,it can be combined with bronchoscopic or gastroscopic surgery if necessary.

Objective:To explore the clinical value of syndecan-1 (SDC1), asymmetric dimethylarginine (ADMA) assessment in the early diagnosis and course monitoring of patients with type 2 diabetic kidney disease (DKD).Methods:This is a cross-sectional study. A total of 232 patients with type 2 diabetes admitted to the Department of Endocrinology of Kailuan General Hospital from December 2020 to December 2021 were included. The general biochemical indexes, SDC1 and ADMA were detected. According to urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), patients were divided into simple diabetes group (50 cases) and DKD group (182 cases). According to the risk of progression of DKD, the DKD group was further divided into low-progression diabetic nephropathy (LDKD) subgroup (90 cases), medium-progression diabetic nephropathy(MDKD)subgroup (55 cases), and high-progression diabetic nephropathy(HDKD) subgroup (37 cases). Forty healthy people undergoing physical examination during the same period in our hospital were selected as the healthy control group. According to the quartile value of N-acetyl-β-D-glucosaminase/urinary creatinine (NAG/Ucr), the DKD group was divided into Q1- Q4 subgroups, with 45, 45, 46 and 46 cases, respectively. Spearman correlation was used to analyze the correlation between SDC1, ADMA and glomerular and renal tubule injury indexes in DKD patients. Multifactor ordered Logistic regression was used to analyze the influencing factors of the progression risk of DKD and renal tubular injury. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SDC1 and ADMA for DKD. Results:The levels of systolic blood pressure, diastolic blood pressure, triglyceride (TG), serum creatinine (Scr), uric acid (UA), NAG/Ucr, SDC1 and ADMA in DKD group were higher than those in SDM group and healthy control group (all P<0.05). The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and hemoglobin A1c (HbA 1c) in DKD group were higher than those in healthy control group, and the level of high density lipoprotein cholesterol (HDL-C) was lower than that in healthy control group (all P<0.05). The SDC1 level in HDKD subgroup was higher than that in SDM group and LDKD subgroup, and the ADMA level was higher than that in SDM group and lower than that in LDKD subgroup (all P<0.05). SDC1 level in MDKD subgroup was higher than that in SDM group and LDKD subgroup, ADMA level was higher than that in SDM group, but lower than that in LDKD subgroup (all P<0.05).The levels of SDC1 and ADMA in LDKD subgroup were higher than those in SDM group (all P<0.05). The levels of TC, AporB, HbA 1c, Scr, UACR and SDC1 in NAG/Ucr Q4 subgroup were higher than those in Q1 subgroup, the levels of Scr, UACR and SDC1 were higher than those in Q2 subgroup, and the levels of HbA 1c, Scr, UACR and SDC1 in Q3 subgroup were higher than those in Q1 subgroup (all P<0.05). Spearman correlation analysis showed that SDC1 was positively correlated with UACR, NAG/Ucr ( r=0.757, 0.566, all P<0.05),and was negatively correlated with eGFR ( r=-0.337, P<0.05). ADMA was positively correlated with UACR, NAG/Ucr ( r=0.197, 0.142, all P<0.05). Multifactor ordered Logistic regression analysis showed that SDC1, NAG/Ucr and Scr were the independent influencing factors of progression risk in DKD patients ( OR=2.043, 1.067, 1.047, 0.660, 1.394, all P<0.05), while SDC1, HbA 1c and ACR were the independent influencing factors of renal tubule injury in DKD patients ( OR=1.177, 1.193, 1.002,all P<0.05). ROC curve showed that the area under the curve (AUC) of SDC1 for DKD diagnosis was 0.979, the sensitivity was 92.31%, and the specificity was 92.22%, while the AUC of ADMA for DKD diagnosis was 0.745, the sensitivity was 81.32%, and the specificity was 60.00%. The AUC, sensitivity and specificity of the combined diagnosis of DKD were 0.981, 90.66% and 95.66%. Conclusions:SDC1 is an independent risk factor of DKD progression and tubular injury in DKD patients, which can be used to diagnose early DKD and monitor the progression of DKD. ADMA is suitable for early screening of DKD.

Objective:To explore the feasibility of using ligation clip-assisted modified " expansion and co-llapse method" to determine the intersegment plane in thoracoscopic resection of the external posterior basal segment (S 9+ 10) in children with congenital pulmonary airway malformation (CPAM). Methods:Retrospective study.The clinical data of 12 CPAM children who underwent thoracoscopic S 9+ 10 resection in Children′s Hospital Affiliated to Shandong University from July 2019 to May 2021 were collected and analyzed.There were 7 males and 5 females.The age at operation ranged from 3.50 to 11.50 months.The body weight of patients ranged from 6.5 to 11.5 kg.In all the patients, the ligation clip-assisted modified " expansion and collapse method" was applied during the operation to determine the intersegment plane (S 9+ 10 was in the expansion state and the remaining lungs were in the collapse state) before thoracoscopic S 9+ 10 resection.After S 9+ 10 resection, the surgical treatment and postoperative recovery were summarized and analyzed. Results:All the operations were completed under thoracoscopy, and there was no conversion to thoracotomy.In 11 patients, the intersegment plane was accurately determined by the ligation clips-assisted improved " expansion and collapse method" , and the S 9+ 10 segment was successfully resected.Of these 11 cases, 8 cases had right S 9+ 10 resection and 3 cases had left S 9+ 10 resection.In the process of using the ligation clip-assisted improved " expansion and collapse method" to determine the intersegment plane, the operator needed to clamp the ligation clip after the anesthesiologist expanded the lung completely.Because the operation was not stable enough, the ligation clip fell off and did not clamp S 9+ 10, resulting in operation failure.The operation was changed to the traditional " expansion and collapse method" . Besides, the basal segment bronchus was cut off by mistake, so the right basal segment had to be resected.The operation time ranged from 85 to 205 min, with a median of 149 min.Intraoperative bleeding ranged from 5 to 15 mL, with a median of 10 mL.The indwelling time of drainage tubes ranged from 2 to 4 days, with a median of 3 days.The postoperative hospital stay ranged from 5 to 8 days, with a median of 6 days.Postoperative pathological examination results suggested 4 cases of type 1, 6 cases of type 2 and 2 cases of type 3.There were 2 cases of simple subcutaneous emphysema without postoperative complications such as bleeding, bronchopleural fistula and atelectasis.The follow-up time ranged from 6 to 28 months, with a median of 15 months.The chest CT of all children showed no residual lesions and no residual cavities in the involved hemithorax. Conclusions:Ligation clip-assisted improved " expansion and collapse method" for determining the intersegment plane is suitable for CPAM children with a narrow thoracic space, and the operation is simple and effective.It is relatively safe and feasible to use this method in S 9+ 10 resection.

It is very important for epilepsy treatment to distinguish epileptic seizure and non-seizure. In this study, an automatic seizure detection algorithm based on dual density dual tree complex wavelet transform (DD-DT CWT) for intracranial electroencephalogram (iEEG) was proposed. The experimental data were collected from 15 719 competition data set up by the National Institutes of Health (NINDS) in Kaggle. The processed database consisted of 55 023 seizure epochs and 501 990 non-seizure epochs. Each epoch was 1 second long and contained 174 sampling points. Firstly, the signal was resampled. Then, DD-DT CWT was used for EEG signal processing. Four kinds of features include wavelet entropy, variance, energy and mean value were extracted from the signal. Finally, these features were sent to least squares-support vector machine (LS-SVM) for learning and classification. The appropriate decomposition level was selected by comparing the experimental results under different wavelet decomposition levels. The experimental results showed that the features selected in this paper were different between seizure and non-seizure. Among the eight patients, the average accuracy of three-level decomposition classification was 91.98%, the sensitivity was 90.15%, and the specificity was 93.81%. The work of this paper shows that our algorithm has excellent performance in the two classification of EEG signals of epileptic patients, and can detect the seizure period automatically and efficiently.
Algorithms ; Electroencephalography ; Epilepsy/diagnosis* ; Humans ; Seizures/diagnosis* ; Signal Processing, Computer-Assisted ; Support Vector Machine ; Wavelet Analysis

The construction of clinical teaching faculty team in the practice base for master of nursing specialist plays an important role in the clinical practice and training process of nursing postgraduates with professional master's degree. This study comprehensively retrieves relevant domestic literature, summarizes the current status, core competence, access standards, training requirements and other research progress of teaching faculty team construction in the domestic practice base for master of nursing specialist and explores the urgent need for teaching faculty team construction in practice bases for master of nursing specialist, so as to provide a reference for construction of teaching faculty team in the practice base for master of nursing specialist.

Animals ; Bacterial Infections/metabolism* ; Glucose/metabolism* ; Homeostasis ; Insulin Secretion ; Mice ; Mice, Knockout ; Sirtuins/metabolism*

During 2 years,a 6-year-old girl was hospitalized for 2 times with recurrent onset of episodes of vomiting,weakness and fever after eating dessert at the Department of Neurology & Endocrine Pediatrics,the Affiliated Hospital of Qingdao University.The arterial blood gas analysis revealed severe hypoglycemia,lacticacidemia and metabolic acidosis,the urine ketone body was positive.After intravenous infusion of glucose,bicarbonate and antibiotics,there was a dramatic clinical improvement in a short time.Physical examination showed tachypnea and mild hepatomegaly,and she had normal physical and mental development.The laboratory findings revealed transient hyperuricacidemia.Urine organic acids analysis repeatedly showed an elevation of lactic acid,ketone and glycerol.Glyceroluria was a very distinctive trait.The literatures in PubMed was searched with glyceroluria as keyword.Three related diseases were identified:FBPase deficiency,glycerol kinase (GK) deficiency and complex GK deficiency.Further reading of related literatures to understand the characteristics of diseases and laboratory tests,the clinical diagnosis of GK deficiency and complex GK deficiency was excluded.The mutation analysis of FBPase gene (FBP1) was performed by Sanger sequencing and a novel compound heterozygous mutations of c.355G ＞A and c.960delG was discovered.Full analysis of disease-related traits and targeted gene testing is one of the effective methods for accurate diagnosis and treatment of inherited metabolic disorders.

Objective To observe and evaluate the clinical effect of pure hemodialysis (HD﹚, hemodialysis combined with hemoperfusion (HD+HP﹚, hemodialysis combined with hemodiafiltration (HDF﹚ on onuremic patients. Methods All 90 patients with uremic in our hospital from January 2011 to May 2014 were randomly divided into HD group, (HD+HP﹚ group,HDF group according to the treatment methods, 30 cases in each group. After two months,the skin itching symptoms and blood toxin levels before and after treatment in each group of were compared. Results Before treatment,Pi, Scr and BUN levels were not significantly different between groups(P>0.05﹚. After treatment the Pi, Scr and BUN levels were significantly decreased compared with those before treatment(P<0.05﹚. No significant differences between groups(P>0.05﹚. Before treatment,three groups of PTH, β2-MG and Cys C level had no significant difference (P>0.05﹚.After treatment,three groups of PTH,β2-MG and Cys C levels were significantly decreased than before treat-ment(P<0.05﹚.Multiple comparisons between groups showed that the indexes of the level of (HD+HP﹚group was lower than that of the other two groups (P<0.05﹚.(HD+HP﹚ group,HDF group of skin pruritus symptom improvement rate were higher than those in HD group (P<0.05﹚,but (HD+HP﹚groups, HDF groups had no significant difference (P>0.05﹚. Conclusion Scavenging effects of HD,(HD+HP﹚and HDF to the small molecules are roughly the same,but scavenging effect of(HD+HP﹚and HDF for large, middle molecular substances are better than those of HD,so (HD+HP﹚ has the best effect.

Objective To evaluate the efficacy and safety of telbivudine for pregnant women with hepatitis Be antigen (HBeAg)negative chronic hepatitis B(CHB). Methods Sixty-two cases of HBeAg negative CHB pregnant women were collected from May 2007 to May 2012,and they were divided into telbivudine group (n=31 ,600 mg per day by oral administration)and compound glycyrrhizin group (n=31 ,120 mg per day by intravenous administration).All neonates were given intramuscular injection of 200 IU hepatitis Bimmune globalin at birth immediately and 15 days after birth,and 20 μg genetically engineered hepatitis B vaccine at 0,1 and 6 months after birth.The serum alanine aminotransferase (ALT)level and hepatitis B virus (HBV)DNA titer were monitored.The HBV DNA negative conversion rate,the rate of intrauterine infection,duration of pregnancy,delivery mode,neonate weight and disability rate were compared between groups.All categorical data were analyzed using the chi-square test and comparison between groups was analyzed by t test.Results In telbivudine group,the HBV DNA level before delivery ([0.20±0.11]lg copy/mL)and 6 weeks after delivery ([0.22±0.13]lg copy/mL) were lower than that before treatment [(6.24±0.75 )lg copy/mL]and the differences were statistically significant (t=303.128 and 301 .321 ,respectively;both P <0.01).The negative conversion rate of HBV DNA in telbivudine group was 28 cases before delivery,while in compound glycyrrhizin group,no one had HBV DNA negative conversion.And statistical significant differences were achieved between these two groups before delivery and 6 weeks after delivery (t = -20.285 and -8.721 ,respectively;both P <0.01).In telbivudine group,the ALT levels before delivery and 6 weeks after delivery were (13.08±5.87) U/L and (25.97 ± 17.48)U/L,respectively,which were significantly decreased compared with that before treatment (205.95± 95.69 )U/L.The differences were statistically significant (t = 93.128 and 81.321, respectively;both P <0.01).In compound glycyrrhizin group,the ALT level before delivery ([104.15 ± 69.15]U/L)was lower than that before treatment ([209.60 ± 102.24]U/L)and the difference was statistically significant (t = 9.281 ,P =0.032).However,the ALT level was fluctuant 6 weeks after delivery (150.26± 86.43)U/L,which was not significantly different from that before treatment (t =2.821 ,P =0.122).The ALT levels before delivery and 6 month after delivery were significantly different in both two groups (t=-2.559 and -3.158,respectively;both P <0.05 ).There were no statistically significant differences between these two groups in the rate of intrauterine infection, duration of pregnancy,delivery mode,neonate weight and disability rate.Conclusion The using of telbivudine for pregnant women with HBeAg negative CHB can effectively control the hepatitis activation and reduce the virus titer.