Objective:To study the feasibility and safety of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ.Methods:Clinical data of 60 patients with liver tumors treated at Jinhua Central Hospita from January 2018 to September 2022 were retrospectively collected, including 40 males and 20 females, aged (51.5±4.5) years. Perioperative data on operative time, intraoperative blood loss, postoperative time of ambulation, postoperative time to flatulate, duration of hospital stay, pathological type, complications (bile leakage, pleural effusion, etc.) were analyzed. Postoperative follow-ups were conducted through telephone reviews, outpatient visits.Results:Of 57 patients (95.0%) successfully underwent the surgery, while three cases (5.0%) were converted to open surgery due to excessive intraoperative bleeding. The operative time was (210.5±20.5) min. The intraoperative blood loss was (220.5±50.5) ml. The postoperative time of ambulation was (1.5±0.5) d, and the postoperative time to flatulate was (2.0±0.8) d. The postoperative hospital stay was (7.2±1.5) d. Bile leakage occurred in four cases (6.7%) after surgery, which was managed by conservative treatment, and pleural effusion occurred in eight cases (13.3%), which recovered after puncture and drainage. Postoperative pathology included 40 cases (66.7%) of hepatocellular carcinoma, three cases (5.0%) of intrahepatic cholangiocarcinoma, five cases (8.3%) of liver metastases, seven cases (11.7%) of hepatic hemangioma, two case (3.3%) of angiomyolipoma, and three case (5.0%) of focal hepatic nodular hyperplasia. No tumor recurrence was observed during follow-up (median 26 months; range 18-40 months).Conclusion:The application of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ is safe and feasible.

Objective To investigate the safety and clinical efficacy of the Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle in laparoscopic anatomical central hepatectomy.Methods 24 patients underwent laparoscopic anatomical central hepatectomy via Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle from January 2023 to June 2024 were selected.Statistical analysis of patients with operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 24 patients underwent laparoscopic anatomical central hepatectomy without perioperative death.The operation time was(210.2±75.6)minutes(range:95～295 min),and the intraoperative blood loss was(358.9±118.4)mL(range:150～1 100 mL).There was no intraoperative blood transfusion and no conversion to open surgery.The abdominal drainage tube was removed on the average of(5.5±0.5)d(range:4～10 d)after operation,and the average postoperative hospital stay was(7.5±1.5)d(range:5～16 d).There were 5 cases of Clavien-Dindo grade Ⅰ and Ⅱ complications,including 4 cases of abdominal effusion and 1 case of pleural effusion.Postoperative pathology:all patients were hepatocellular carcinoma.Patients with liver malignant tumor were followed up for 1 month to 1.5 years.All the patients survived during the follow-up period,and 2 patients had tumor recurrence.Conclusion For central hepatic segment tumors,laparoscopic anatomical central hepatectomy can be performed using the left hepatic parenchyma via Laennec membrane priority approach combined with APR triangle method,which is safe and feasible.

Objective To investigate the safety and clinical efficacy of the Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle in laparoscopic anatomical central hepatectomy.Methods 24 patients underwent laparoscopic anatomical central hepatectomy via Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle from January 2023 to June 2024 were selected.Statistical analysis of patients with operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 24 patients underwent laparoscopic anatomical central hepatectomy without perioperative death.The operation time was(210.2±75.6)minutes(range:95～295 min),and the intraoperative blood loss was(358.9±118.4)mL(range:150～1 100 mL).There was no intraoperative blood transfusion and no conversion to open surgery.The abdominal drainage tube was removed on the average of(5.5±0.5)d(range:4～10 d)after operation,and the average postoperative hospital stay was(7.5±1.5)d(range:5～16 d).There were 5 cases of Clavien-Dindo grade Ⅰ and Ⅱ complications,including 4 cases of abdominal effusion and 1 case of pleural effusion.Postoperative pathology:all patients were hepatocellular carcinoma.Patients with liver malignant tumor were followed up for 1 month to 1.5 years.All the patients survived during the follow-up period,and 2 patients had tumor recurrence.Conclusion For central hepatic segment tumors,laparoscopic anatomical central hepatectomy can be performed using the left hepatic parenchyma via Laennec membrane priority approach combined with APR triangle method,which is safe and feasible.

Objective:To study the feasibility and safety of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ.Methods:Clinical data of 60 patients with liver tumors treated at Jinhua Central Hospita from January 2018 to September 2022 were retrospectively collected, including 40 males and 20 females, aged (51.5±4.5) years. Perioperative data on operative time, intraoperative blood loss, postoperative time of ambulation, postoperative time to flatulate, duration of hospital stay, pathological type, complications (bile leakage, pleural effusion, etc.) were analyzed. Postoperative follow-ups were conducted through telephone reviews, outpatient visits.Results:Of 57 patients (95.0%) successfully underwent the surgery, while three cases (5.0%) were converted to open surgery due to excessive intraoperative bleeding. The operative time was (210.5±20.5) min. The intraoperative blood loss was (220.5±50.5) ml. The postoperative time of ambulation was (1.5±0.5) d, and the postoperative time to flatulate was (2.0±0.8) d. The postoperative hospital stay was (7.2±1.5) d. Bile leakage occurred in four cases (6.7%) after surgery, which was managed by conservative treatment, and pleural effusion occurred in eight cases (13.3%), which recovered after puncture and drainage. Postoperative pathology included 40 cases (66.7%) of hepatocellular carcinoma, three cases (5.0%) of intrahepatic cholangiocarcinoma, five cases (8.3%) of liver metastases, seven cases (11.7%) of hepatic hemangioma, two case (3.3%) of angiomyolipoma, and three case (5.0%) of focal hepatic nodular hyperplasia. No tumor recurrence was observed during follow-up (median 26 months; range 18-40 months).Conclusion:The application of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ is safe and feasible.

Objective To investigate the safety and clinical efficacy of the combined gallbladder plate approach using Laennec membrane based on APR triangle in laparoscopic anaphylactic right lobe hepatectomy.Methods Clinical data of 27 patients underwent laparoscopic anaphylactic of right lobe hepatectomy based on the APR triangle combined with the gallbladder plate approach using Laennec membrane were collected from January 2021 to December 2023.The relevant data of patients were statistically analyzed,including operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 27 patients underwent laparoscopic anatomic hepatectomy,and no perioperative death occurred.Among them,segment Ⅴ was resected in 4 cases,segment Ⅵ in 3 cases,segment Ⅴ+Ⅷ in 6 cases,segment Ⅴ+Ⅵ in 4 cases,segment Ⅵ+Ⅶin 5 cases,segment Ⅴ+Ⅵ+Ⅶ in 3 cases,and segment Ⅴ+Ⅵ+Ⅷ in 2 cases.All cases belonged to the China Liver Cancer(CNLC)clinical staging,stage Ⅰa in 15 cases,stage Ⅰb in 8 cases and stage Ⅱa in 4 cases.The operative time was(258.3±62.3)min,the intraoperative blood loss was(168.8±48.1)mL,and there was no transfusion.The patients were given liquid diet on the first day after surgery,and were active in bed on the second day after surgery.The mean postoperative length of hospital stay was(6.5±1.7)d after removal of abdominal drainage tube.There were 5 cases of Clavien-Dindo Ⅰ and Ⅱ complications(3 cases of abdominal effusion,1 case of pleural effusion,1 case of pulmonary infection),and no complications such as bile leakage and abdominal hemorrhage occurred.Postoperative pathology:21 cases of hepatocellular carcinoma,4 cases of hepatociliary duct carcinoma,2 cases of liver metastasis.Patients with liver malignant tumor were followed up for 2 months to 2 years,and all patients survived during the follow-up period without tumor recurrence.Conclusion The gallbladder plate approach based on APR triangle combined with Laennec membrane is a safe and effective surgical method for laparoscopic anaphylactic right lobe hepatectomy,which is worthy of clinical application.

Objective:To establish a method for determintation of chlorogenic acid and linarin in Yejuhua granules by HPLC.Methods:We applied HPLC methods. The Kromasil 100-5 C18 column (250 mm×4.6 mm,5 μm) was used, the mobile phase was acetonitrile-0.4%H 3PO 4 solution (gradient elution), the flow rate was 1.0 ml/min, the dection wavelenghth was 334 nm and the column temperture was 32 ℃. Results:Chlorogenic acid and buddleoside had good linearity in the ranges of 0.30-1.50 μg ( r2=0.999 1) and 0.12-0.62 μg ( r2=0.999 8), respectively. The average recoveries were 99.70% and 96.67%, with RSD<2%, respectively. Conclusion:The method is simple, rapid, reliable, efficient, and can be used for determination of chlorogenic acid and buddleoside in Yejuhua Granules.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.

Objective:To investigate the clinical characteristics and prognosis of children with septic shock caused by invasive pneumococcal diseases (IPDs) in pediatric intensive care unit (PICU).Methods:The clinical data of children diagnosed as septic shock caused by IPDs and hospitalized in the intensive care unit (ICU) of Beijing Children′s Hospital, Capital Medical University and the PICU of Henan Children′s Hospital from January 2013 to August 2019 were retrospectively collected, and the clinical characteristics and prognosis of these patients were analyzed.Results:Twenty-one children were included, with a median age of 1.2 (0.75, 3.90) years old.The pediatric index of mortality 2 (PIM-2) at admitting was (23.3±29.6)%, and 6 cases had underlying diseases.Main sites of infection included blood flow (20 cases) and suppurative meningitis (15 cases). The drug sensitivity test was performed on 18 children, among who 9 cases were sensitive to Penicillin, 10 cases to Cefepime, 11 cases to Cefotaxime and 10 cases to Meropenem.All 18 patients were sensitive to Vancomycin and Linezolid.Seven cases and 13 cases were treated with sensitive antibiotics at the disease onset and before septic shock, respectively.In 21 cases whose lactic acid level was (6.1±4.6) mmol/L, the shock redress time of 10 cases was (10.9±10.1)h, and 13 cases (61.9%) died (14.6±12.2) hours after septic shock, among who 10 died of transforamed magna herniation.The PIM-2 score at admitting into PICU and the rate of intracranial hypertension crisis in the death group were significantly higher than those in the survival group [(37.1±30.3)% vs.(0.9±1.3)%, 69.9% (9/13 cases) vs.25.0% (2/8 cases)](all P<0.05). There was no significant difference in age and the utilization rate of effective antibiotics before septic shock between the two groups (all P<0.05). Four of the surviving 8 children had severe cerebral functional disability. Conclusions:Septic shock caused by IPD is more common in children under 5 years old, and the most common sites are blood flow and intracranial infection.It has high resistance rate against Cephalosporins and Carbopenem.Patients with purulent meningitis are easy to develop intracranial hypertension crisis, which has an extremely high mortality and morbidity, so it needs to be identified and treated early.

Objective:To evaluate the efficacy and safety of nasal continuous positive airway pressure(NCPAP) in the treatment of congenital airway stenosis with severe pneumonia.Methods:A single-center retrospective clinical study was used to select children with congenital airway stenosis and pneumonia who were admitted to PICU of Beijing Children′s Hospital of Capital Medical University during 5 years and treated with NCPAP within 48 hours after admission.The baseline data, clinical manifestations, vital signs, arterial blood gas, clinical outcomes, NCPAP use time and adverse reactions were collected.Results:A total of 64 children were included in this study, with 58 cases in the effective group and six cases in the ineffective group.The total effective rate of NCPAP was 90.6% (58/64) during 5 years.In the effective group, 63.8% patients were weaned in three to seven days, with an average weaning time of 6.09 days.In the effective group, the heart rate and PaCO 2 after NCPAP treatment were significantly lower than that before treatment, and pH and PaO 2 were significantly higher than that before treatment, and the difference was statistically significant (all P<0.05). A total of six patients in the ineffective group were finally changed to tracheal intubation and invasive ventilation.The survival rate of both groups was 100%.All cases had no adverse reactions or complications. Conclusion:NCPAP can effectively improve the oxygenation in children with congenital airway stenosis and severe pneumonia, with high efficiency and good safety.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.