To explore the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) combined with modified biopsy forceps for suspected malignant biliary obstruction, 72 patients with suspected malignant biliary obstruction who underwent ERCP using modified biopsy forceps from January 2017 to April 2023 in the First Affiliated Hospital of Henan University of Chinese Medicine were selected as the modified group, while 61 contemporaneous patients who underwent ERCP with traditional biopsy forceps were selected as the control group at the same time. The stenosis site was identified during the operation, and the effective pathological tissue was obtained by biopsy. Benign or malignant tumor was determined according to the medical history and clinical follow-up data. The sensitivity and specificity of the two groups were compared. The success rate of biopsy was 100.00% in the two groups. All patients had no serious complications and were diagnosed histologically. Sixty-seven cases were finally diagnosed as malignant and 5 cases were benign in the modified group. In the control group, 58 cases were malignant and 3 cases were benign. The sensitivity for diagnosis of malignant biliary stricture was 79.10% (54/67) in the modified group, and 60.34% (35/58) in the control group, with significant difference ( χ2=6.218, P= 0.013). The specificity of the two methods for the diagnosis of malignant stenosis was 100.00%. Therefore, it is safe and effective to apply ERCP combined with the modified biopsy forceps in the diagnosis of extrahepatic malignant bile duct stenosis.

To explore the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) combined with modified biopsy forceps for suspected malignant biliary obstruction, 72 patients with suspected malignant biliary obstruction who underwent ERCP using modified biopsy forceps from January 2017 to April 2023 in the First Affiliated Hospital of Henan University of Chinese Medicine were selected as the modified group, while 61 contemporaneous patients who underwent ERCP with traditional biopsy forceps were selected as the control group at the same time. The stenosis site was identified during the operation, and the effective pathological tissue was obtained by biopsy. Benign or malignant tumor was determined according to the medical history and clinical follow-up data. The sensitivity and specificity of the two groups were compared. The success rate of biopsy was 100.00% in the two groups. All patients had no serious complications and were diagnosed histologically. Sixty-seven cases were finally diagnosed as malignant and 5 cases were benign in the modified group. In the control group, 58 cases were malignant and 3 cases were benign. The sensitivity for diagnosis of malignant biliary stricture was 79.10% (54/67) in the modified group, and 60.34% (35/58) in the control group, with significant difference ( χ2=6.218, P= 0.013). The specificity of the two methods for the diagnosis of malignant stenosis was 100.00%. Therefore, it is safe and effective to apply ERCP combined with the modified biopsy forceps in the diagnosis of extrahepatic malignant bile duct stenosis.

OBJECTIVE To investigate the efficacy and safety of ropivacaine combined with oxycodone for the analgesia of iliac fascia nerve block in patients undergoing hip replacement.METHODS Sixty-six patients who underwent hip replacement at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from October 2023 to April 2024 were selected and randomly divided into observation group and control group,with 33 cases in each group.Before induction of anesthesia,ultrasound-guided iliac fascial nerve block was performed.Patients in the observation group were treated with 0.33%ropivacaine+0.1 mg/kg oxycodone injection mixture 30 mL,and patients in the control group were treated with 0.33%ropivacaine injection 30 mL.The time of first postoperative rescue analgesia,24 h postoperative analgesic drug consumption,sensory block and motor block effective and maintenance time,satisfaction degree,numerical rating scale(NRS)pain score,Ramsay sedation score,muscle strength score,heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2),sleep score,anxiety score,and the occurrence of adverse reactions in the two groups were all recorded.RESULTS Compared with the control group,the first rescue analgesia time after operation was significantly prolonged in the observation group,and 24 h postoperative analgesic drug consumption after operation decreased;the effective time of sensory block was significantly shortened,and the maintenance time of sensory block was significantly prolonged,and the satisfaction score was higher;the NRS pain score after iliac fascia nerve block was lower,HR and MAP were lower,and the anxiety score and sleep score 24 and 48 h after operation were lower(P＜0.05).In terms of safety,patients in both groups had adverse reactions after operation,such as hypertension,nausea,vomiting,and dizziness,but there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).CONCLUSIONS Oxycodone combined with ropivacaine shows good efficacy and safety for iliac fascial nerve block analgesia in patients undergoing hip replacement,can significantly prolong the analgesic time of ropivacaine,reduce postoperative analgesic drug consumption,improve the sleep quality of patients,and promote the rapid recovery of patients.

Objective To investigate the detection rate,epidemiology and resistance mechanism of methicil-lin-resistant Staphylococcus aureus(MRSA)in a hospital in recent 5 years.Methods A total of 762 strains of non repetitive Staphylococcus aureus detected from 2016 to 2020 in a hospital were collected retrospectively.Methicillin-sensitive Staphylococcus aureus(MSSA)was 392 strains(MSSA group)and 370 strains caused by MRSA(MRSA group),and 95 strains of MRSA isolated in 2020 were further used for resistance mechanism.Staphylococcus aureus was identified and tested for drug sensitivity by Vitek 2 automatic microbial system.Molecular epidemiological typing was determined by multilocus sequence typing.The biofilm formation was performed by crystal violet staining.PCR amplification was used to detect drug resistance genes,virulence genes and biofilm related genes,and logistic regression analysis was used to investigate the independent risk factors of its occurrence.Results The detection rate of MRSA in past five years was 48.56％,mainly was from pus samples and secretion samples(38.38％,33.51％respectively).MRSA was found in the general sur-gery(18.65％)and otorhinolaryngology(12.70％).ST88 was the most common multilocus sequence typing(37.89％),and followed by ST951(24.21％).Moderate biofilm formation was the most common,accounting for 74.73％.Multivariate regression analysis showed that compared with MSSA group,hypoproteinemia,en-docrine system diseases,wound infection and history of antibiotic use within six months were the independent risk factors for infection in MRSA group.Compared with the control group,hospital transfer,wound infection and tumor were independent risk factors for infection in MRSA group(P＜0.05).Conclusion The detection rate of MRSA in a hospital is high,and the carrying rate of various drug-resistant genes is high.The hospital should pay attention to the prevalence of MRSA and related risk factors,so as to prevent it early.

Objective:In this study, the collected mosquito samples were subjected to viral isolation to identify the species and branch characteristics of arboviruses in five regions of Shanxi Province.Methods:Eight arboviruses in mosquito samples collected from July to September 2020 were detected by real-time fluorescent quantitative PCR, and virus isolation was carried out through cell culture. Virus isolates were identified and analyzed by molecular biology and bioinformatics method.Results:We detected 1 batch of positive samples of Japanese encephalitis virus, 2 batches of positive samples of Culex flavivirus and 8 batches of positive samples of Nam Dinh virus among 121 batches of mosquito samples. Seven virus isolates were isolated, numbered: SX-YJ-Cxp-4、SX-YJ-Ars-2、SX-YJ-Cxp-1、SX-LY-Cxp-10、SX-GP-Ars-5、SX-GP-Cxp-2、SX-GP-Cxp-4, all of which were identified as Nam Dinh virus, and the whole genome sequencing was performed on one of them, and the result showed that Shanxi Nam Dinh virus isolate and Yunnan Nam Dinh virus isolate belonged to the same evolutionary branch.Conclusions:Nam Dinh virus was isolated and identified on the specimen from Shanxi province for the first time.

Objective:To explore the influencing factors of immune checkpoint inhibitor-related pneumonitis (CIP) in lung cancer patients caused by programmed cell death 1 receptor (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors.Methods:A retrospective analysis was conducted on clinical data of lung cancer patients treated with PD-1/PD-L1 inhibitors in the First Affiliated Hospital of Guangzhou Medical University from January 2018 to June 2022. Patients with CIP were included in the CIP group, and those who did not experience any immune-related adverse events during the same period were screened in a 1∶1 ratio and included in the control group. The clinical characteristics in patients of the 2 groups were compared and influencing factors of CIP were analyzed using binary logistic regression method. The effect sizes were the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 246 patients (123 in the CIP group and 123 in the control group) were entered in the analysis, including 208 males and 38 females, aged (63±9) years with a range of 32 to 86 years. The diagnosis was non-small-cell lung cancer in 234 patients and small cell lung cancer in 12 patients. There were no statistically significant differences in age, gender, history of respiratory diseases, tumor histological types, TNM stages, and types of immune checkpoint inhibitors used in patients between the 2 groups (all P>0.05). Compared with the control group, patients in the CIP group had a lower body mass index [(21.5±3.2) kg/m 2vs. (22.6±3.0) kg/m 2, P=0.004], higher proportion of patients with Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) ≥2 points[39.0% (48/123) vs. 22.0% (27/123), P=0.004], higher proportion of patients with a history of radiation therapy [25.2% (31/123) vs. 13.8% (17/123), P=0.024], and lower proportion of patients with combination therapy with chemotherapy/targeted drugs[82.9%(102/123) vs. 97.6%(120/123), P<0.001]. Before immunotherapy, the peripheral blood interleukin-1β and interferon-α were lower [1.97 (1.04, 2.74) ng/L vs. 2.40 (1.75, 4.03) ng/L, P=0.021; 2.08 (0.89, 3.00) ng/L vs. 2.76 (1.97, 3.94) ng/L, P=0.012], lymphocyte count was lower [1.4(1.0, 1.8)×10 9/L vs. 1.5(1.2, 2.1)×10 9/L, P=0.030], and the neutrophil-to-lymphocyte ratio was higher [3.85 (2.50, 6.40) vs. 3.11 (2.25, 4.61), P=0.006] in patients of the CIP group than those in the control group. The binary logistic regression analysis showed that baseline ECOG-PS ≥2 points ( OR=3.400, 95% CI: 1.180-9.798, P=0.023) and combination of PD-1/PD-L1 inhibitors and chemotherapy/targeted therapy ( OR=0.047, 95% CI: 0.005-0.454, P=0.008) were independent influencing factors for the occurrence of CIP. Conclusion:The ECOG-PS ≥ 2 points before immunotherapy is an influencing factor for CIP, and the combination with chemotherapy/targeted therapy may reduce the risk of developing CIP in patients treated with PD-1/PD-L1 inhibitors.

Objective:To explore the influencing factors of immune checkpoint inhibitor-related pneumonitis (CIP) in lung cancer patients caused by programmed cell death 1 receptor (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors.Methods:A retrospective analysis was conducted on clinical data of lung cancer patients treated with PD-1/PD-L1 inhibitors in the First Affiliated Hospital of Guangzhou Medical University from January 2018 to June 2022. Patients with CIP were included in the CIP group, and those who did not experience any immune-related adverse events during the same period were screened in a 1∶1 ratio and included in the control group. The clinical characteristics in patients of the 2 groups were compared and influencing factors of CIP were analyzed using binary logistic regression method. The effect sizes were the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 246 patients (123 in the CIP group and 123 in the control group) were entered in the analysis, including 208 males and 38 females, aged (63±9) years with a range of 32 to 86 years. The diagnosis was non-small-cell lung cancer in 234 patients and small cell lung cancer in 12 patients. There were no statistically significant differences in age, gender, history of respiratory diseases, tumor histological types, TNM stages, and types of immune checkpoint inhibitors used in patients between the 2 groups (all P>0.05). Compared with the control group, patients in the CIP group had a lower body mass index [(21.5±3.2) kg/m 2vs. (22.6±3.0) kg/m 2, P=0.004], higher proportion of patients with Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) ≥2 points[39.0% (48/123) vs. 22.0% (27/123), P=0.004], higher proportion of patients with a history of radiation therapy [25.2% (31/123) vs. 13.8% (17/123), P=0.024], and lower proportion of patients with combination therapy with chemotherapy/targeted drugs[82.9%(102/123) vs. 97.6%(120/123), P<0.001]. Before immunotherapy, the peripheral blood interleukin-1β and interferon-α were lower [1.97 (1.04, 2.74) ng/L vs. 2.40 (1.75, 4.03) ng/L, P=0.021; 2.08 (0.89, 3.00) ng/L vs. 2.76 (1.97, 3.94) ng/L, P=0.012], lymphocyte count was lower [1.4(1.0, 1.8)×10 9/L vs. 1.5(1.2, 2.1)×10 9/L, P=0.030], and the neutrophil-to-lymphocyte ratio was higher [3.85 (2.50, 6.40) vs. 3.11 (2.25, 4.61), P=0.006] in patients of the CIP group than those in the control group. The binary logistic regression analysis showed that baseline ECOG-PS ≥2 points ( OR=3.400, 95% CI: 1.180-9.798, P=0.023) and combination of PD-1/PD-L1 inhibitors and chemotherapy/targeted therapy ( OR=0.047, 95% CI: 0.005-0.454, P=0.008) were independent influencing factors for the occurrence of CIP. Conclusion:The ECOG-PS ≥ 2 points before immunotherapy is an influencing factor for CIP, and the combination with chemotherapy/targeted therapy may reduce the risk of developing CIP in patients treated with PD-1/PD-L1 inhibitors.

Objective:To evaluate the deformity changes in the treatment of congenital clubfoot in infants by ultrasound, and to explore its clinical application value.Methods:Seventeen infants with congenital clubfoot treated in the Department of Pediatric Orthopaedics of the Third Affiliated Hospital of Zhengzhou University from March 2020 to June 2021 and 27 normal infants in the same period were selected. The distance between medial malleolus and scaphoids (MM-N distance) of all feet was measured by ultrasound. The distance from the tangent line of the lateral edge of calcaneus to the midpoint of the lateral edge of the chondroid bone (C-C distance), medial soft tissue thickness and tibial calcaneal angle were measured by ultrasound. The data before, after treatment and during follow-up were statistically analyzed.Results:A total of 88 feet of 44 infants were evaluated. The mean number of cast was 4.7±1.1, the follow-up time was (96.9±59.3)days. The MM-N distance, C-C distance and posterior tibial calcaneal angle in the clubfoot group were improved after treatment and at the last follow-up, and the differences were statistically significant (all P<0.01). During the treatment, 1 case had false correction, and 2 cases recurred in the last follow-up. Conclusions:Ultrasound can clearly display the medial, dorsal, lateral and posterior articular structures of normal and clubfoot, and can observe the deformity changes of clubfoot during the correction process, which can provide guidance for the clinical treatment of clubfoot.

The clinical data of 69 patients with non-HIV-related cryptococcal meningitis admitted in the Second Hospital of Hebei Medical University from January 2013 to May 2019 were analyzed retrospectively.The main presentations of 69 patients are headache,fever,nausea,vomiting, visual impairment, hearing damage.Among them, 36 cases (52%) had underlying diseases, 30 cases (43%) were misdiagnosed, and 38 cases (55%) were complicated with high intracranial pressure. Cerebrospinal fluid examination showed that leukocytes increased in 47 cases, protein increased in 55 cases, chloride decreased in 41 cases, glucose decreased in 34 cases. The imaging findings were cerebral ischemia, hydrocephalus, meningeal or cerebral parenchyma enhancement. During the induction period, 63 cases were treated with combined antifungal drugs and 6 cases were treated with single antifungal drugs. The clinical symptoms were improved in 54 cases, 9 cases were discharged automatically and 6 cases died. The clinical manifestations, routine and biochemical examination of cerebrospinal fluid, imaging findings are not specific for patients with non-HIV-related cryptococcal meningitis.So early and multiple lumbar puncture should be performed to find etiological evidence to reduce misdiagnosis. The combination of antifungal drugs during the induction period is safe and effective.

Objective To investigate the relationship between rs17525495 locus polymorphism of leukotriene A4 hydrolase (LTA4H) gene and the severity of tuberculous meningitis (TBM). Methods A total of 184 TBM patients from Department of Neurology, the Second Hospital of Hebei Medical University from January 2014 to October 2016 were selected as research subjects. According to the British Medical Research Council criteria, the severity of TBM patients was divided into three stages. The single nucleotide polymorphism rs17525495 of LTA4H gene was sequenced, and the general case data, clinical manifestations and results of lumbar puncture were analyzed. Results There were 91 cases (49.5％) of CC genotypes of rs17525495 locus in LTA4H gene of 184 cases, 75 cases (40.8％) of CT genotypes and 18 cases (9.8％) of TT genotypes. The frequency of allele C was 69.8％ and T was 30.2％. Patients with different genotypes were compared for their severity, clinical manifestations and lumbar puncture results. Among CC patients, the proportion of stage Ⅰ patients(54.9％, 50/91)was higher than that of stage Ⅱ(22.0％, 20/91)and Ⅲ(23.1％, 21/91). Among TT patients, the proportion of patients with stage Ⅱ(8/18)and Ⅲ(8/18)was higher than patients with stageⅠ(2/18)(χ2=15.898,P=0.003). The incidence of headache, fever, nausea and vomiting, neck stiffness, epilepsy and disturbance of consciousness was statistically analyzed. Compared with CC and CT patients, the incidence of fever(TT:13/18,CC:42/91,CT:50/75,χ2=8.932,P=0.011)and neck stiffness(TT:12/18,CC:38/91,CT:46/75,χ2=7.993,P=0.018)was higher in TT patients. Headache, nausea and vomiting, disturbance of consciousness, and the incidence of epilepsy showed no statistically significant difference. And there was no statistically significant difference in lumbar puncture pressure, chloride, protein and glucose between different genotypes. Conclusion TBM patients with mild illness frequently prompt LTA4H gene rs17525495 locus for the CC type;while patients with severe disease prompt TT type.