Objective:To explore the feasibility and adaptability of laparoscopy in the surgical treatment of splenic aneurysm.Methods:The data of 28 patients with splenic aneurysms who underwent laparoscopic surgery in the Department of Hepatobiliary and Pancreatic Surgery of the Third Affiliated Hospital of Soochow University from January 2010 to December 2023 were retrospectively collected and analyzed. Among them, there were 13 males and 15 females, with the age of (57.3±7.7) years. All patients underwent laparoscopic splenic aneurysm resection, and whether to perform splenic artery anastomosis or splenectomy was determined based on the intraoperative situation. Collect the long diameter and location of splenic aneurysms, intraoperative blood loss, operation time, postoperative complications (bleeding, pancreatic fistula, splenic infarction, and splenic vein and portal vein thrombosis), postoperative hospital stay and hospitalization expenses of the patients.Results:All patients successfully underwentlaparoscopic surgery for splenic aneurysms. Aneurysms were located at the origin of the splenic artery in 3 cases (10.7%), in the middle in 8 cases (28.6%), and at the tail in 17 cases (60.7%). The long diameter of the aneurysms was (3.1±1.7) cm. Among the 28 patients, 18 cases (64.3%) underwent splenic aneurysm resection alone, 5 cases (17.9%) underwent splenic aneurysm resection combined with end-to-end anastomosis of the splenic artery, and 5 cases (17.9%) underwent splenic aneurysm resection combined with splenectomy. The operation time of 28 patients was (124.3±55.1) min, the intraoperative blood loss was 100.0 (50.0, 162.5) ml, the postoperative hospital stay was (10.9±3.8) days, and the hospitalization cost was (3.7±1.2) wanyuan. Among the 28 patients, 5 cases (17.9%) developed pancreatic fistula, 1 case (3.6%) had partial splenic infarction, and 1 case (3.6%) had portal vein and splenic vein thrombosis after the operation.Conclusion:Laparoscopic surgery for splenic aneurysm is safe and feasible, with less surgical trauma and quick postoperative recovery.

A 77-year-old male patient was admitted to the hospital with the main cause of memory loss, visual hallucination for more than one year, aggravated for two months with sensitivity and paranoia. The patient exhibited signs of loss of smell, axial hypertonia, upper limb hypertonia, slow start, and propulsive gait. Cranial MRI suggested cerebral atrophy, bilateral hippocampal atrophy, and multiple cavernous cerebral infarcts. Severe memory deficits, moderate intellectual deficits, MMSE score of 12, mildly abnormal electroencephalography, and polysomnographic monitoring suggested a high likelihood of apnea syndrome. Prior to the onset of the disease, the patient had a history of swinging, shouting, and cursing during nighttime sleep, according to his family members. The final diagnosis was Lewy body dementia.

Objective:To explore the risk factors for severe acute kidney injury (AKI) in children with sepsis in the pediatric intensive care unit (PICU) and construct a prediction model to assist early clinical identification.Methods:A retrospective analysis was performed on clinical data of 987 children with sepsis admitted to the PICU of Hunan Children′s Hospital from July 1, 2018 to January 31, 2021. Children who developed severe AKI during hospitalization were included in the AKI stage 2-3 group ( n=228), and the remaining were included in the No-AKI/AKI stage 1 group ( n=759). General information and biochemical indicators were compared between the two groups. Logistic regression analysis was used to identify risk factors for severe AKI in children with sepsis, and a prediction model and nomogram were established. Results:The mortality rate in the AKI stage 2-3 group was 2.49 times that of the No-AKI/AKI stage 1 group [31.1%(71/228) vs 12.5%(95/759), P<0.05]. Compared with the No-AKI/AKI stage 1 group, the AKI stage 2-3 group had lower levels of platelet count (PLT), total protein (TP), albumin (ALB), antithrombin Ⅲ (AT3), and fibrinogen (FIB), but higher levels of lactate dehydrogenase (LDH), serum creatinine (SCr), blood urea nitrogen (BUN), magnesium ion (Mg 2+ ), activated partial thromboplastin time (APTT), fibrinogen degradation products (FDP), and D-dimer (D-D) (all P<0.05), with no significant difference in total bile acid (TBAC) ( P>0.05). Multivariate logistic regression analysis showed that decreased AT3 ( OR=0.989, 95% CI: 0.980-0.997, P=0.007), increased LDH ( OR=1.001, 95% CI: 1.000-1.001, P<0.001), increased SCr ( OR=1.051, 95% CI: 1.037-1.066, P<0.001), and increased BUN ( OR=1.099, 95% CI: 1.028-1.174, P=0.005) were risk factors for severe AKI in children with sepsis. The prediction model was Logist Pr=-3.184-0.012 X1+ 0.001 X2+ 0.050 X3+ 0.094 X4 ( X1=AT3, X2=LDH, X3=SCr, X4=BUN), with the optimal cut-off value of 0.374 (Youden index=0.560). A nomogram was constructed by binary assignment of predictive variables, with an area under the curve of 0.826 (95% CI: 0.790-0.861, P<0.001). Conclusions:The mortality rate of septic children with severe AKI in PICU is significantly increased. Decreased AT3, and increased LDH, SCr, and BUN are risk factors for severe AKI in children with sepsis. Clinicians should be alert to severe AKI when the predicted probability of the early warning model exceeds 0.374.

Objective To investigate the effectiveness and safety of electroconvulsive therapy(ECT)in reducing suicidal ideation and depressive symptoms of major depressive disorder patients,as well as its effect on cognitive function.Methods A total of 160 adolescent patients with major depressive disorder were recruited for this study.The ECT group(n=81)received conventional antidepressant medication combined with 8 sessions of electroconvulsive therapy,and the control group(n=79)received conventional antidepressant medication only.Depressive symptoms,suicidal ideation,and cognitive functioning were assessed using 17-item Hamilton rating scale for depression(HAMD-17)and self-rating idea of suicide scale(SIOSS),at baseline(before ECT),after ECT,and at 2 and 6 weeks after treatment.The Montreal cognitive assessment(MoCA)was used to evaluate the cognitive function of the patients,and the patients were followed up for side effects such as dizziness and nausea.Results Generalized estimating equation(GEE)analysis of HAMD-17 and SIOSS scores showed significant group×time interaction effects(P<0.01).Both groups exhibited a reduction in HAMD-17 scores before and after treatment(scores at four time points:ECT group 24.59±4.56 vs.13.25±4.32 vs.6.20±1.95 vs.3.62±2.04,control group 23.48±3.66 vs.15.42±3.11 vs.10.10±2.05 vs.4.68±2.01;P<0.01).The mean difference in HAMD-17 scores before and after treatment was-9.62±3.13 in the ECT group,and was-8.16±1.71 in the control group.Additionally,suicidal ideation reduced in both groups after treatment(SIOSS scores at four time points:ECT group 18.57±2.85 vs.10.93±3.52 vs.8.02±2.79 vs.3.70±1.96,control group 18.97±3.03 vs.15.51±2.98 vs.11.11±2.18 vs.6.44±1.78;P<0.01).For cognitive function scores,there was no interaction between group and time(P=0.21),the difference in the change in MoCA scores at different follow-up time points was significant(P<0.01),and the difference in the change in MoCA scores between the two groups was not significant(P=0.05),and the cognitive functions of the two groups could be restored to the baseline level at 6 weeks after treatment.No severe side effects were reported in either group of patients during the study.Conclusions Our findings confirm that ECT is effective and safe for improving suicidal ideation and depressive symptoms in adolescents with major depressive disorder.The impairment of cognitive function by ECT in adolescent patients with major depressive disorder is reversible.

Objective To investigate the effectiveness and safety of electroconvulsive therapy(ECT)in reducing suicidal ideation and depressive symptoms of major depressive disorder patients,as well as its effect on cognitive function.Methods A total of 160 adolescent patients with major depressive disorder were recruited for this study.The ECT group(n=81)received conventional antidepressant medication combined with 8 sessions of electroconvulsive therapy,and the control group(n=79)received conventional antidepressant medication only.Depressive symptoms,suicidal ideation,and cognitive functioning were assessed using 17-item Hamilton rating scale for depression(HAMD-17)and self-rating idea of suicide scale(SIOSS),at baseline(before ECT),after ECT,and at 2 and 6 weeks after treatment.The Montreal cognitive assessment(MoCA)was used to evaluate the cognitive function of the patients,and the patients were followed up for side effects such as dizziness and nausea.Results Generalized estimating equation(GEE)analysis of HAMD-17 and SIOSS scores showed significant group×time interaction effects(P<0.01).Both groups exhibited a reduction in HAMD-17 scores before and after treatment(scores at four time points:ECT group 24.59±4.56 vs.13.25±4.32 vs.6.20±1.95 vs.3.62±2.04,control group 23.48±3.66 vs.15.42±3.11 vs.10.10±2.05 vs.4.68±2.01;P<0.01).The mean difference in HAMD-17 scores before and after treatment was-9.62±3.13 in the ECT group,and was-8.16±1.71 in the control group.Additionally,suicidal ideation reduced in both groups after treatment(SIOSS scores at four time points:ECT group 18.57±2.85 vs.10.93±3.52 vs.8.02±2.79 vs.3.70±1.96,control group 18.97±3.03 vs.15.51±2.98 vs.11.11±2.18 vs.6.44±1.78;P<0.01).For cognitive function scores,there was no interaction between group and time(P=0.21),the difference in the change in MoCA scores at different follow-up time points was significant(P<0.01),and the difference in the change in MoCA scores between the two groups was not significant(P=0.05),and the cognitive functions of the two groups could be restored to the baseline level at 6 weeks after treatment.No severe side effects were reported in either group of patients during the study.Conclusions Our findings confirm that ECT is effective and safe for improving suicidal ideation and depressive symptoms in adolescents with major depressive disorder.The impairment of cognitive function by ECT in adolescent patients with major depressive disorder is reversible.

Objective:To explore the feasibility and adaptability of laparoscopy in the surgical treatment of splenic aneurysm.Methods:The data of 28 patients with splenic aneurysms who underwent laparoscopic surgery in the Department of Hepatobiliary and Pancreatic Surgery of the Third Affiliated Hospital of Soochow University from January 2010 to December 2023 were retrospectively collected and analyzed. Among them, there were 13 males and 15 females, with the age of (57.3±7.7) years. All patients underwent laparoscopic splenic aneurysm resection, and whether to perform splenic artery anastomosis or splenectomy was determined based on the intraoperative situation. Collect the long diameter and location of splenic aneurysms, intraoperative blood loss, operation time, postoperative complications (bleeding, pancreatic fistula, splenic infarction, and splenic vein and portal vein thrombosis), postoperative hospital stay and hospitalization expenses of the patients.Results:All patients successfully underwentlaparoscopic surgery for splenic aneurysms. Aneurysms were located at the origin of the splenic artery in 3 cases (10.7%), in the middle in 8 cases (28.6%), and at the tail in 17 cases (60.7%). The long diameter of the aneurysms was (3.1±1.7) cm. Among the 28 patients, 18 cases (64.3%) underwent splenic aneurysm resection alone, 5 cases (17.9%) underwent splenic aneurysm resection combined with end-to-end anastomosis of the splenic artery, and 5 cases (17.9%) underwent splenic aneurysm resection combined with splenectomy. The operation time of 28 patients was (124.3±55.1) min, the intraoperative blood loss was 100.0 (50.0, 162.5) ml, the postoperative hospital stay was (10.9±3.8) days, and the hospitalization cost was (3.7±1.2) wanyuan. Among the 28 patients, 5 cases (17.9%) developed pancreatic fistula, 1 case (3.6%) had partial splenic infarction, and 1 case (3.6%) had portal vein and splenic vein thrombosis after the operation.Conclusion:Laparoscopic surgery for splenic aneurysm is safe and feasible, with less surgical trauma and quick postoperative recovery.

A 77-year-old male patient was admitted to the hospital with the main cause of memory loss, visual hallucination for more than one year, aggravated for two months with sensitivity and paranoia. The patient exhibited signs of loss of smell, axial hypertonia, upper limb hypertonia, slow start, and propulsive gait. Cranial MRI suggested cerebral atrophy, bilateral hippocampal atrophy, and multiple cavernous cerebral infarcts. Severe memory deficits, moderate intellectual deficits, MMSE score of 12, mildly abnormal electroencephalography, and polysomnographic monitoring suggested a high likelihood of apnea syndrome. Prior to the onset of the disease, the patient had a history of swinging, shouting, and cursing during nighttime sleep, according to his family members. The final diagnosis was Lewy body dementia.

Objective:To explore the risk factors for severe acute kidney injury (AKI) in children with sepsis in the pediatric intensive care unit (PICU) and construct a prediction model to assist early clinical identification.Methods:A retrospective analysis was performed on clinical data of 987 children with sepsis admitted to the PICU of Hunan Children′s Hospital from July 1, 2018 to January 31, 2021. Children who developed severe AKI during hospitalization were included in the AKI stage 2-3 group ( n=228), and the remaining were included in the No-AKI/AKI stage 1 group ( n=759). General information and biochemical indicators were compared between the two groups. Logistic regression analysis was used to identify risk factors for severe AKI in children with sepsis, and a prediction model and nomogram were established. Results:The mortality rate in the AKI stage 2-3 group was 2.49 times that of the No-AKI/AKI stage 1 group [31.1%(71/228) vs 12.5%(95/759), P<0.05]. Compared with the No-AKI/AKI stage 1 group, the AKI stage 2-3 group had lower levels of platelet count (PLT), total protein (TP), albumin (ALB), antithrombin Ⅲ (AT3), and fibrinogen (FIB), but higher levels of lactate dehydrogenase (LDH), serum creatinine (SCr), blood urea nitrogen (BUN), magnesium ion (Mg 2+ ), activated partial thromboplastin time (APTT), fibrinogen degradation products (FDP), and D-dimer (D-D) (all P<0.05), with no significant difference in total bile acid (TBAC) ( P>0.05). Multivariate logistic regression analysis showed that decreased AT3 ( OR=0.989, 95% CI: 0.980-0.997, P=0.007), increased LDH ( OR=1.001, 95% CI: 1.000-1.001, P<0.001), increased SCr ( OR=1.051, 95% CI: 1.037-1.066, P<0.001), and increased BUN ( OR=1.099, 95% CI: 1.028-1.174, P=0.005) were risk factors for severe AKI in children with sepsis. The prediction model was Logist Pr=-3.184-0.012 X1+ 0.001 X2+ 0.050 X3+ 0.094 X4 ( X1=AT3, X2=LDH, X3=SCr, X4=BUN), with the optimal cut-off value of 0.374 (Youden index=0.560). A nomogram was constructed by binary assignment of predictive variables, with an area under the curve of 0.826 (95% CI: 0.790-0.861, P<0.001). Conclusions:The mortality rate of septic children with severe AKI in PICU is significantly increased. Decreased AT3, and increased LDH, SCr, and BUN are risk factors for severe AKI in children with sepsis. Clinicians should be alert to severe AKI when the predicted probability of the early warning model exceeds 0.374.

Objective:To explore the differences in clinical characteristics and treatment outcomes between patients with type A and type B alcohol dependence, and to find the independent risk factors of relapse.Methods:Alcohol-dependent male patients attending the Addiction Medicine Center of Beijing Huilongguan Hospital from January 2018 to December 2020 were selected for the study and divided into type A alcohol-dependent group ( n=77) and type B alcohol-dependent group ( n=87). All patients were given acute detoxification treatment and were followed up after treatment on relapse to drinking. Differences in demographic and clinical data were compared between the two groups, and differences in treatment outcomes between the two groups at different time points over 3 months were compared. Patients were divided into relapse group and non-relapse group according to whether they drank again after 3 months. Logistic regression model was established to screen the risk factors of relapse of alcohol-dependent patients by SPSS 25.0 software. Results:There was no significant difference between the two types of patients in years of education, marital status, smoking status and working status(all P>0.05), but the proportion of co-residents( χ2=5.69, P=0.017) and the proportion of positive family history of alcoholism were significant difference between the two type of patients( χ2=13.32, P<0.001). There were statistically significant differences between the two types of patients in the onset time( t=-7.28, P<0.001), the first drinking age( t=-2.36, P=0.020), the proportion of drinking in the morning( χ2=7.83, P=0.005), psychotic symptoms( χ2=4.31, P=0.038), convulsions after withdrawal( χ2=5.30, P=0.021), and alcohol use disorder identification test(AUDIT) score( t=4.30, P<0.001). At the 4th and 8th weekend of the follow-up, there were statistically significant differences in drinking frequency(0(0, 3), 0(0, 0), Z=-4.13, P<0.001; 3(0, 3), 0(0, 3), Z=-4.42, P<0.001) and relapse rate (40(45.98%), 9(11.69%), χ2=22.92, P<0.001; 61(70.11%), 24(31.17%), χ2=24.82, P<0.001) between the two types of alcohol dependence patients after drinking again. After 12-week follow-up, there were statistically significant differences between the two types of alcohol-dependent patients in the interval of first drinking(20(7, 30)d, 88(38, 90)d, Z=-7.83, P<0.001), the cumulative duration of abstinence(4(0, 8)weeks, 12(4, 12)weeks, Z=-5.13, P<0.001), the cumulative rate of abstinence(71(81.60%), 25(32.47%), χ2=40.62, P<0.001), the frequency of drinking after abstinence(3(3, 3), 0(0, 3), Z=-5.54, P<0.001), and the reduction of daily average alcohol consumption( t=3.36, P<0.001). Logistic regression model showed that type B alcohol dependence ( OR=3.121, P=0.03, 95% CI: 1.12-8.72) and AUDIT score ( OR=1.498, P<0.01, 95% CI: 1.29-1.74) were the risk factors for relapse of alcohol-dependent patients. Conclusions:Patients with type A and type B alcohol dependence have obvious differences in clinical characteristics and treatment outcomes, and type B alcohol dependence is independent risk factor for relapse to drinking in alcohol-dependent patients, which validate the rationality and necessity of alcohol dependence subtypes.

Objective This study was aimed to evaluate the short-term antidepressive effect and the cognitive decline of the acute modified electroconvulsive therapy (MECT) course with 20％ and 40％ sub-threshold electricity stimulus dose in patients suffered with major depressive disorder.Methods A total of 108 patients who met the DSM-Ⅳ criteria of depression were enrolled and,according to the RAND procedure in excel,were randomly assigned into 3 groups:20％ electricity group,40％ electricity group,and 80％ electricity group (control),with 36 cases each accordingly.All patients were given one 8 times MECT with consecutively 5 times in the first week followed by intermittently 3 times in the second week (once every the other day).Depression symptoms (assessed by HAMD17) and the cognitive function (assessed by the Repeatable Battery for the Assessment of Neuropsychological Status,RBANS) were evaluated at baseline,4 to 8 hours after the first treatment,4 to 8 hours after the last treatment,the end of the week-4 and the week-8.The results were compared by repeated measurement analysis of variance and one-way analysis of variance (ANOVA).Results (1) There were significant differences in HAMD17 (F=10.769,P＜0.05) and RBANS (F=6.961,P＜0.05) among the three groups.(2) The time × electricity group interactions of HAMD17 (F=3.450,P＜0.05) and RBANS (F=2.501,P＜0.05) scoring were of statistical significance.(3) The scores of HAMD17 after the last treatment (F=3.673,P＜0.05),at week-4 (F=4.570,P＜0.05),and week-8 (F=4.122,P＜0.05) presented with significant difference among the three groups.There was no significant difference between either group and the control (P＞0.05).However,there was significant difference in HAMD17 between the 20％ electricity group and the 40％ electricity group (P＜0.05).(4) After the last treatment of MECT,the scores of RBANS among all three groups were significantly different (F=7.890,P＜0.05).And compared to the control (55.2 ± 11.2),the cognitive level measured by RBANS scores was relatively preserved in 20％ (65.2±12.2) and 40％ (63.9±11.5) electricity groups(P＜0.05).At week-8,the scores of RBANS (F=2.770,P＞ 0.05) were not significantly different among the three groups.Conclusion Subthreshold MECT with the stimulus dose at 40％ electricity seems not much different in antidepressive efficacy from the standard electricity dose,and the adverse impact on the cognitive function is relatively less.The efficacy of the 20％ electricity dose is poor though the cognitive decline is also minimal.