Objective To observe the changes in the symptoms and relevant physiological indicators in subjects after inhaling the hypoxic air produced by a hypoxic air generator at a low altitude prior to their entry into high-altitude environment,and to explore its early warning effect for acute mountain sickness(AMS)among the subjects upon their subsequent entry into high-altitude environment.Methods A total of 50 subjects who were going to visit high-altitude regions were enrolled.All subjects were men,with an average age of(22.00±1.52)years.They continuously inhaled for 30 minutes hypoxic air(which simulated the air at the altitude of 5200 m,with an oxygen content 10.80％)generated by a hypoxic air generator.During this period fingertip oxygen saturation,heart rate,blood pressure,and symptoms of discomfort were observed and recorded.On the fourth day after living at an altitude of 4020 m,the subjects completed the evaluation for the symptom scores of acute mild altitude disease(AMAD).The subjects were divided into a maladjusted group(18 cases)and a well-adjusted group(32 cases)according to whether they experienced discomfort(including drowsiness,dizziness,chest tightness,cold sweating of the hands,etc.)during the inhalation of hypoxic air at a low altitude.After entry into the high-altitude environment,they were divided into an AMS group(28 cases)and a non-AMS group(22 cases)according to whether they experienced AMS after entering the he high-altitude environment.The primary indicator was the incidence of AMS,including the incidence of AMAD and severe acute mountain sickness(SAMS),and the incidence of AMS in the maladjusted group and the well-adjusted group after entering high-altitude environment.The secondary indicator was the relationship between the changes in fingertip oxygen saturation after inhaling hypoxic air at a low altitude and the incidence of AMS and the AMAD symptom scores.Results All 50 subjects traveled by air to the target altitude of 4020 m above sea level at the same time.The AMS incidence among them was 56.0％(28/50),with the incidence of AMAD being 54.0％(27/50)and the incidence of SAMS being 2.0％(1/50).In the single case of SAMS,the patient had high-altitude pulmonary edema.The incidences of AMS after entering high-altitude environment in the maladjusted and well-adjusted groups were 88.9％(16/18)and 37.5％(12/32),respectively,and the difference was statistically significant(P＜0.01).In the 50 subjects,fingertip oxygen saturation decreased rapidly in the first 11 minutes into the inhalation of hypoxic air at a low altitude,with a more pronounced decrease in the AMS group than that in the non-AMS group,and the differences between the groups were statistically significant after 5,9,and 11 minutes(P＜0.05).Fingertip oxygen saturation plateaued in the 50 subjects from the 12th to the 30th minute,with no significant differences between the AMS and non-AMS groups.The mean value of fingertip oxygen saturation within 30 minutes of hypoxic air inhalation was negatively correlated with the AMAD symptom scores after subjects'entry into high-altitude environment(r=-0.300).Conclusion Those who experience symptoms of discomfort after exposure to hypoxic air produced by a hypoxic air generator at a low altitude are more likely to develop AMS and close attention should be paid to the decrease in fingertip oxygen saturation within the first 11 minutes.

Objective:To learn about the current situation of prevention and control of coal-burning-borne endemic fluorosis (coal burning fluorosis for short) in Yunnan Province, and comprehensively evaluate the implementation effect of prevention and control measures.Methods:From August to November 2020, according to the requirements of the Monitoring Program of Yunnan Province for Coal-burning-borne Endemic Fluorosis (2019 edition), monitoring was carried out in all natural villages in the disease areas of 13 counties (cities and districts, hereinafter referred to as counties) of the province, and 30 households were selected from each natural village to monitor the use of stoves and the formation of related healthy living behaviors. At the same time, children aged 8 - 12 years in the natural villages in the disease areas were examined for the prevalence of dental fluorosis. The evaluation for control and elimination of disease areas was carried out in accordance with the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition).Results:A total of 392 244 households were investigated, and the rates of qualified improved stoves, the correct utilization of qualified improved stoves and correct drying of corn and pepper were 99.42% (389 982/392 244), 99.70% (388 796/389 982) and 99.07% (388 579/392 244), respectively. A total of 227 057 children aged 8 - 12 years were examined, 9 413 children of dental fluorosis were detected, the detection rate of dental fluorosis was 4.15%, the dental fluorosis index was 0.10, and the prevalence intensity was negative. Taking the county as a unit, except Fuyuan and Zhenxiong, which reached the control standard of the disease area, the remaining 11 counties reached the elimination standard.Conclusion:The prevention and control measures on coal burning fluorosis are implemented well in Yunnan Province and healthy lifestyle has gradually taken shape, with the overall condition of the disease reduced.

Objective To understand the current situation on coal-burning-borne endemic fluorosis control and prevention in Yunnan Province,timely discover problems in prevention and control of the disease,and achieve the "13th Five-Year Plan" objectives as scheduled.Methods Simple random sampling method was adopted to conduct investigations in Weixin County,Daguan County of Zhaotong City,and Fuyuan County of Qujing City in the key diseased areas of Yunnan Province in 2017.Three townships from each endemic fluorosis area were randomly selected,and 2 villages of each township were randomly selected.The use of improved stoves (types of stoves,integrity rate and correct use),knowledge and behavior changes of endemic fluorosis prevention among local grade five pupils and housewives or household heads and the condition of endemic fluorosis (dental fluorosis and urinary fluoride situation in children) were investigated in above mentioned villages.Results A total of 532 households were investigated.The consumption rate of self-produced corn and pepper were 53.4％ (284/532) and 44.7％ (238/532),respectively.Totally 81.0％ (431/532) of households burned coal,the average annual coal burning time per household was 6.3 months.Totally 44.5％ (237/532) of the households used the improved iron stove,89.5％ (476/532) used the electric cooker to cook rice,84.2％ (448/532) used the induction cooker to cook,and 36.7％ (195/532)used the portable open stove.The integrity rate of improved stoves and the correct usage rate were 86.9％ (206/237) and 84.0％ (199/237),respectively,among the 237 households using improved stoves.The awareness rate of the prevention and control of coal-burning-borne fluorosis in grade five pupils and housewives or household heads were 85.8％ (921/1 074) and 17.7％ (283/1 596),respectively.The correct drying rates of edible corn and peppers were 66.5％ (189/284) and 52.9％ (126/238),respectively.A total of 3 333 children aged 8-12 years old were examined and the dental fluorosis positive rate was 11.28％ (376/3 333).Totally 377 samples of immediate urine samples were detected,the geometric mean of urinary fluoride content of children was 0.37 (0.06-2.14) mg/L.Conclusions The situation of coal-burning-borne endemic fluorosis in Yunnan Province is effectively controlled,but the correct use rate of improved stoves,the correct drying rate of edible com and peppers are low,and do not meet the requirements of the "13th Five-Year Plan".

Objective: To explore the safety and feasibility of associating diaphragm resection and liver-diaphragmatic metastasis lesions resection for patients with advanced ovarian cancer. Methods: Retrospectively analysis 83 cases(98 times) of advanced ovarian cancer with liver-diaphragmatic metastasis between January 2012 and December 2016 at Department of Liver Surgery, Peking Union Medical College Hospital.The patients were aged from 19 to 75 years.Surgical procedure included metastatic lesions resection(43 times) and stripping(55 times). Operation status, post-operative complications, pathology results and follow-up of the patients were analyzed. Results: Fifteen patients received twice surgical treatment and 68 patients received one time surgical treatment. Postoperative hemorrhage in chest and between liver and diaphragm was not occurred in all cases.Dyspnea and low oxygen saturation were occurred in two cases of stripping patients and 1 case of metastatic lesions resection patients.Results of CT examination indicated that there was medium to large amount of ascites in right chests.The symptoms were relieved after placing thoracic closed drainage.Other patients were recovered smoothly.All patients were diagnosed as ovarian cancer by pathological examination. Conclusion Associating diaphragm resection is safe and feasible for liver-diaphragmatic metastasis lesions from ovarian cancer.

Objective To summarize the clinical diagnosis and treatment of nodular regenerative hyperplasia of the liver. Methods Retrospective analysis was made on the clinical manifestations,imagings, laboratory tests, diagnosis, treatment and prognosis of 18 consecutive cases finally established as NRH during the past 26 years. Results 15 of the 18 cases showed portal hypertension, 4 cases showed mono or multiple occupations of the liver, 8 cases suffered from concurrent autoimmune diseases, 3 cases were suspected of blood diseases. Preoperatively, 13 cases were diagnosed as cirrhosis, 2 cases were diagnosed as liver cancer or focal nodular hyperplasia ( FNH). All cases were diagnosed by operative wedging biopsy. 3 cases received splenectomy, 4 cases received disconnection /Phemister surgery, 3 cases received liver occupation/liver lobe resection, 1 case received partial small bowel resection, and 1 case received spleen artery restrictive surgery. Postoperatively, symptoms of portal hypertension relieved obviously. Follow-up study showed most of the patients were stable and prognosis of the NRH was good.Conclusions NRH may relate to the disturbance of liver blood supply, and most common clinical manifestation is portal hypertension, and can combine with immune diseases, hematopathy also can present single or multiple liver occupations. Differential diagnoses include liver cirrhosis, FNH, idiopathic portal hypertension. Diagnosis of NRH relies on liver wedging biopsy. Surgery can relive concurrent portal hypertension.

Objective To investigate the effect and long-term prognosis of patients who underwent hepatectomy for hepatolithiasis. Methods We retrospectively analyzed the medical records of 98 patients with hepatolithiasis who were treated by hepatectomy in Peking Union Medical College Hospital.Results Male/femah:1/1.7;median age:55 years old.58 cases(59.2%)had been treated before;among them.50 by surgery.In 88 cages(89.8%)hepatolithiasis involved the left lobe only,in 2(2.0%) only the right lobe involved.and in 8(8.2%)both left and right lobe were involved.51(52.0%)had extrahepatic biliary stones,30(30.6%)had biliary duct strictures,28(28.6%)had a history of biliary ascariasis.and 5(5.1%)had a concurrent biliary tract malignancy.All received partial hepatectomy according to the stone location;for the 8 bilaterally involved patients,left hepatectomy and right lithotomy were performed.Postoperative complications occurredin 14 cases(14.3%),and there were2perioperative deaths(2.0%).Seventy-eight patients(79.6%)have beenfollowedupfor over1 yearwith no tumors;the results were excellent or good in 91.0%;the stone residue and recurrence rate were both 2.0%.Conclusions Hepatectomy not only eliminates calcuci,but also removes diseased biliary tracts,with advantages of low residue stone and recurrence rate.

Objective To investigate the impact of vascular inflow occlusion of the liver on arterial lactate level and pH value. Methods In this study, 68 patients who underwent hepatectomy from January 2006 to December 2008 were retrospectively studied. The patients were assigned to one of the three study groups according the vascular inflow status: clamping of portal vein and hepatic artery in the hepatic pedicle (n = 20), hemihepatectomy under total hemihepatic vascular exclusion (THVE, n = 22), and non-vascular occlusion (n = 26). Postoperative arterial blood gas analysis including systemic arterial lactate concentration, and liver and renal function tests were performed. Results Systemic arterial blood lactate levels significantly elevated in the portal clamping and THVE groups (5.53 ±2. 31 mmol/L and 5.62 ±2.52mmol/L, respectively), compared to the non-occlusion group (3. 37 ± 1.56 mmol/L, P < 0. 05) ;significant increase in arterial HCO3- level was observed in the THVE group in comparison to the nonocclusion group (19. 68 ± 3. 82) mmol/L vs. (21.65 ± 2. 48) mmol/L, (P < 0. 05). There were no significant differences as to the changes of pH values, liver and renal function tests between the three groups. Conclusions Vascular inflow deprivation may result in significantly increased arterial lactate level. Thus, intense surveillance of blood lactate level with prompt treatment is necessary to prevent postoperative hyperlactatemia and metabolic acidosis.

Objective To evaluate permissive hypocaloric intake in postoperative patients by a prospective, randomized, controlled trial. MethodsForty-two postoperative patients were randomly assigned to receive 117kJ?kg~ -1?d~ -1in control group, and 75kJ?kg~ -1?d~ -1in experimental group intravenously. Blood routine, liver and renal functions were measured one day before and day 1, 3, 5 post operation. Blood glucose level, insulin intervention, infectious complications, hospital stay, and relevant cost were also evaluated. ResultsHypocaloric intake in the experimental group post-operatively did not influence the hemoglobin level, liver function, and other indicators in the serum. The fasting blood glucose and glucose levels after infusion, as well as the volume of insulin intervention were significantly higher in the control group during 4 days of parenteral nutrition. Experimental group had lower relevant hospital cost, while two groups had similar duration of hospital stay. ConclusionPermissive hypocaloric intake shortly after surgery does not influence the patient nutritional status, besides it avoids to some extent the hyperglycemia, reduces the need for insulin intervention .

Objective To study the effect of urinary trypsin inhibitor (UTI) on the release of inflammatory media and oxidation reaction and the mechanism by which UTI protects postoperative liver function following hepatectomy. Methods This was a prospective, randomized, controlled clinical trail, in which cases undergoing hepatectomy were divided into control group (n = 15) and treatment group (n = 15). UTI was administered beginning the day of operation and three days post-op consecutively in the treatment group. Serum CD4, CD8, C-reactive protein(CRP), and gene expressions of IL-1, Il-6, TNF-alpha, iNOS were measured. Results TNF-alpha and iNOS levels significantly decreased in treatment group compared with control 12 hours after surgery (0. 053?0. 02 & 0. 12?0. 04 vs. 0. 084?0. 01 & 0. 21?0. 02, all P

Objective To investigate the effect of Ulinastatin, a urinary trypsin inhibitor on the outcome of patients undergoing liver resection. Methods In this prospective, randomized, and controlled clinical study, 42 patients undergoing hepatectomy were randomly divided into treatment group and control group. In treatment group Ulinastatin was given on the day of surgery and the three consecutive days. Blood was tested for biochemistry. ResultsSerum ALT and AST levels in treatment group were significantly lower than those in control group 12 hours post-operation, especially in patients undergoing multisegmentectomy. Difference became insignificant at the time point of 60 hours post-operation. Administration of Ulinastatin resulted in faster decrease of serum bilirubin level in patients undergoing small volume hepatectomy, and no effect on coagulative function was observed. Conclusions The protective effects of urinary trypsin inhibitor exist mainly in early stage of major liver resection.