Objective:To observe the effect of long-term follow-up of cerebral aneurysm embolization and to explore the related factors of aneurysm recurrence.Methods:A total of 142 cases of intracranial aneurysm rupture embolization patients treated in the Yuebei People′s Hospital from August 2000 to August 2013 were selected as the study objects. All of them underwent embolization treatment, and digital subtraction angiography (DSA), CT angiography (CTA) and magnetic resonance angiography (MRA) were performed after surgery. The follow-up period was 10 years, and the long-term outcome was evaluated using the Stroke Modified Rankin Scale (mRS) score. The results of immediate postoperative angiography and long-term follow-up in different embolization groups were analyzed. The risk factors of recurrence after ruptured cerebral aneurysm embolization were analyzed by single factor and independent risk factors were analyzed by multiple factor.Results:Of 142 patients (161 aneurysms), 106 were embolized by simple embolization and 55 were embolized by stent-assisted embolization. There was no significant difference in the results of immediate embolization between simple embolization and stent assisted embolization ( P>0.05). The proportion of giant aneurysms in the stent-assisted embolization group was higher than that in the simple embolization group ( P<0.05). Follow-up results showed that among the 142 patients, 106 had mRS score 0, 27 had mRS score 1, 5 had mRS score 2, and 4 had mRS score 4. The good clinical prognosis rate was 93.7%(133/142). Of the 161 aneurysms, 36 recurred, with a recurrence rate of 22.4%(36/161). Univariate analysis showed that aneurysm size, cervical tumor and embolization degree were risk factors for cerebral aneurysm recurrence (all P<0.05). The results of multi-factor analysis showed that aneurysm size was an independent risk factor for cerebral aneurysm recurrence ( P<0.05). Conclusions:The long-term follow-up after embolization of cerebral aneurysms is good, but cerebral aneurysms still have the possibility of recurrence. Aneurysm size is an independent risk factor for aneurysm recurrence. Timely detection of cerebrovascular changes can be treated in time to avoid cerebrovascular accidents.

Objective:To evaluate the effect of terlipressin combined with dopamine on intraoperative renal perfusion and early postoperative renal function in patients undergoing living-donor kidney transplantation.Methods:In this prospective cohort study, 84 patients of either sex, aged 18-64 yr, with a body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ, undergoing living-donor kidney transplantation at the First Affiliated Hospital of Zhengzhou University from September 2022 to July 2024, in whom dopamine was continuously infused during operation to maintain fluctuation in the mean arterial pressure within 10% of the baseline value, were selected and divided into dopamine group (group D, n=42) and dopamine+ terlipressin group (group DT, n=42) based on whether terlipressin was used during operation. Terlipressin was continuously infused at a constant rate even before induction in group DT. The renal artery resistance index, intraoperative urine output, urine output within 24 h after surgery, concentration of creatinine within 7 days after surgery, glomerular filtration rate and delayed postoperative transplanted renal function were recorded. Results:Compared with group D, the intraoperative renal vascular resistance index was significantly reduced, the intraoperative urine output was increased ( P<0.01), and no statistical change was found in the urine output within 24 h after surgery, concentration of creatinine within 7 days after surgery, glomerular filtration rate and incidence of delayed postoperative transplanted renal function in group DT ( P>0.05). Conclusions:Terlipressin combined with dopamine provides better efficacy than dopamine alone in improving intraoperative renal perfusion and exerts no effect on early postoperative renal function in patients undergoing living-donor kidney transplantation.

Objective:To evaluate the effect of terlipressin combined with dopamine on intraoperative renal perfusion and early postoperative renal function in patients undergoing living-donor kidney transplantation.Methods:In this prospective cohort study, 84 patients of either sex, aged 18-64 yr, with a body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ, undergoing living-donor kidney transplantation at the First Affiliated Hospital of Zhengzhou University from September 2022 to July 2024, in whom dopamine was continuously infused during operation to maintain fluctuation in the mean arterial pressure within 10% of the baseline value, were selected and divided into dopamine group (group D, n=42) and dopamine+ terlipressin group (group DT, n=42) based on whether terlipressin was used during operation. Terlipressin was continuously infused at a constant rate even before induction in group DT. The renal artery resistance index, intraoperative urine output, urine output within 24 h after surgery, concentration of creatinine within 7 days after surgery, glomerular filtration rate and delayed postoperative transplanted renal function were recorded. Results:Compared with group D, the intraoperative renal vascular resistance index was significantly reduced, the intraoperative urine output was increased ( P<0.01), and no statistical change was found in the urine output within 24 h after surgery, concentration of creatinine within 7 days after surgery, glomerular filtration rate and incidence of delayed postoperative transplanted renal function in group DT ( P>0.05). Conclusions:Terlipressin combined with dopamine provides better efficacy than dopamine alone in improving intraoperative renal perfusion and exerts no effect on early postoperative renal function in patients undergoing living-donor kidney transplantation.

Objective:To observe the effect of long-term follow-up of cerebral aneurysm embolization and to explore the related factors of aneurysm recurrence.Methods:A total of 142 cases of intracranial aneurysm rupture embolization patients treated in the Yuebei People′s Hospital from August 2000 to August 2013 were selected as the study objects. All of them underwent embolization treatment, and digital subtraction angiography (DSA), CT angiography (CTA) and magnetic resonance angiography (MRA) were performed after surgery. The follow-up period was 10 years, and the long-term outcome was evaluated using the Stroke Modified Rankin Scale (mRS) score. The results of immediate postoperative angiography and long-term follow-up in different embolization groups were analyzed. The risk factors of recurrence after ruptured cerebral aneurysm embolization were analyzed by single factor and independent risk factors were analyzed by multiple factor.Results:Of 142 patients (161 aneurysms), 106 were embolized by simple embolization and 55 were embolized by stent-assisted embolization. There was no significant difference in the results of immediate embolization between simple embolization and stent assisted embolization ( P>0.05). The proportion of giant aneurysms in the stent-assisted embolization group was higher than that in the simple embolization group ( P<0.05). Follow-up results showed that among the 142 patients, 106 had mRS score 0, 27 had mRS score 1, 5 had mRS score 2, and 4 had mRS score 4. The good clinical prognosis rate was 93.7%(133/142). Of the 161 aneurysms, 36 recurred, with a recurrence rate of 22.4%(36/161). Univariate analysis showed that aneurysm size, cervical tumor and embolization degree were risk factors for cerebral aneurysm recurrence (all P<0.05). The results of multi-factor analysis showed that aneurysm size was an independent risk factor for cerebral aneurysm recurrence ( P<0.05). Conclusions:The long-term follow-up after embolization of cerebral aneurysms is good, but cerebral aneurysms still have the possibility of recurrence. Aneurysm size is an independent risk factor for aneurysm recurrence. Timely detection of cerebrovascular changes can be treated in time to avoid cerebrovascular accidents.

Objective:To investigate the clinical characteristics and prognostic factors of 2019 novel coronavirus (2019-nCoV) Omicron variant infected cases.Methods:A total of 987 coronavirus disease 2019 (COVID-19) adult imported cases admitted to Shanghai Public Health Clinical Center, Fudan University from July 1, 2021 to January 6, 2022 were recruited. The cases were divided into Omicron group (193 cases) and non-Omicron group (794 cases) according to the genotype of the virus. The clinical data, imaging examination and laboratory results of two groups were collected and compared. Chi-square test and Mann-Whitney U test were used as statistical methods. Multiple linear regression analysis was used for multiple linear regression analysis. Results:The majority of patients in Omicron group were 18 to 30 years old, accounting for 51.3%(99/193), which was higher than 31.4%(249/794) in non-Omicron group. The difference was statistically significant ( χ2=52.75, P<0.001). The proportion of mild cases in Omicron group was 88.6%(171/193), which was higher than 81.6%(648/794) in non-Omicron group. The difference was statistically significant ( χ2=5.37, P=0.021). Cases with symptoms were more common in Omicron group than those in non-Omicron group (60.1%(116/193) vs 29.1%(231/794)), and the difference was statistically significant ( χ2=65.49, P<0.001), with the main clinical manifestations of sore/itchy throat, fever and cough/expectoration. The proportion of cases with pulmonary computed tomography (CT) imaging manifestations at admission in Omicron group was 13.0%(25/193), which was lower than that in non-Omicron group (215/794, 27.1%). The difference was statistically significant ( χ2=16.83, P<0.001). The proportion of cases with 2019-nCoV IgG positive at admission was 47.7%(92/193) in Omicron group, which was lower than 61.1%(485/794) in non-Omicron group, and the difference was statistically significant ( χ2=11.51, P<0.001). The hospitalization time of Omicron group was 20.0 (16.0, 23.0) d, which was longer than that of non-Omicron group (14.0 (10.0, 22.0) d), and the difference was statistically significant ( Z=-7.42, P<0.001). Multiple linear regression analysis showed that the time of hospitalization of cases with 2019-nCoV IgG positive at admission was shorter, while that of the cases with fever in Omicron group was longer (both P<0.050). Conclusions:The main clinical characteristics of cases with Omicron variant are fever and upper respiratory symptoms. Their pulmonary CT imaging manifestations are less, and the time of hospitalization is slightly longer. The time of hospitalization and the virus clearance time in Omicron variant infected cases with 2019-nCoV IgG positive at admission and not presented with fever are both shorter.

Objective:To investigate the value of renal glucose threshold and related factors in patients with type 2 diabetes mellitus.Methods:According to the cut-off point of normal renal glucose threshold(RT G 8.9-10 mmol/L), 107 patients with type 2 diabetes mellitus hospitalized in the Endocrinology Department of our hospital were divided into three groups: high RT G group(RT G>10 mmol/L), medium RT G group(8.9 mmol/L≤RT G≤10 mmol/L), and low RT G group(RT G<8.9 mmol/L). The clinical data and biochemical characteristics of each group were collected and analyzed. Results:The proportions of patients with high, medium, and low RT G of type 2 diabetes mellitus were 56%, 29%, and 15%, respectively. There were significant differences in RT G value, age, course of disease, body mass index(BMI), fasting plasma glucose(FPG), HbA 1C, total cholesterol(TC), serum creatinine, mean blood glucose(MBG), and 24-hour urine glucose between high and medium RT G groups. RT G, gender, BMI, FPG, HbA 1C, TC, and MBG in patients with high RT G group were different from those in low RT G group. Only RT G revealed a difference between medium and low RT G groups. Correlation analysis showed that RT G was positively correlated with gender, age, BMI, HbA 1C, TC, and low density lipoprotein-cholesterol(LDL-C). Regression analysis showed that BMI, HbA 1C, and LDL-C were the related factors affecting the RT G of patients with type 2 diabetes. Conclusion:There is a larger proportion of patients with high RT G in type 2 diabetes mellitus. Their BMI, HbA 1C, and LDL-C are associated with RT G in the patients with type 2 diabetes mellitus.

Objective: To investigate the clinical characteristics and surgical results of patients with chronic subdural hematoma (CSDH) in different age groups. Methods: 150 CSDH patients admitted to our hospital from January 2014 to January 2019 were selected as the research objects, and their clinical data were reviewed and collected. According to different age , they were divided into three groups: the <55 year old group (n=46), the 55-70 year old group (n=62), and the >70 year old group (n=42). The imaging examination results and clinical manifestations of three groups of patients in different age groups were compared. Combined with patients' wishes and surgical indications, 150 patients were treated with traditional burr hole and drainage and modified operation. The results of different operation methods in three groups were compared. Results: The incidence of headache/dizziness in the 55-70 year old group was higher than that in >70 year old group (P<0.05). The incidence of language disorder in the 55-70 year old group and >70 year old group was higher than that in <55 year old group , with statistically significant difference (P<0.05). The incidence of limb paralysis in the 55-70 year old group and the >70 year old group was higher than that in <55 years old group, with statistically significant difference (P<0.05). The incidence of mental disorders in the >70 year old group was higher than that in 55-70 year old group and <55 year old group, with statistically significant difference (P<0.05). The incidence of fecal incontinence in the >70 year old group was higher than that in 55-70 year old group and <55 years old group, with statistically significant difference (P<0.05). The imaging examination results of the three groups showed significant differences (P<0.05). According to the estimation of the amount of hematoma by the Dutian (DOTA) formula, the amount of hematoma in the group of >70 years old was significantly higher than that in the group of <55 years old and 55-70 years old, with statistically significant difference (P<0.05). Among the three groups, the proportion of patients with good prognosis after modified operation was higher than that of traditional operation, and the recurrence rate was lower than that of traditional operation, with statistically significant difference (P<0.05). The proportion of good prognosis and recurrence rate in group >70 years old were lower than those in the group of <55 years old and 55-70 years old (P<0.05). Conclusions CSDH patients of different ages have different characteristics in imaging examination results and clinical manifestations. Traditional burr hole drainage and modified operation can achieve certain results, but modified operation is more effective and can reduce the incidence of postoperative complications, which is worth popularizing.

OBJECTIVETo observe the safety and efficacy of biological patch (Biodesign Surgisis mesh, SIS) in hybrid technique for incisional herniorrhaphy.

METHODSClinical and follow-up data of 14 incisional hernia patients who underwent incisional herniorrhaphy with hybrid technique, using porcine small intestinal submucosa acellular matrix patch, at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to June 31, 2016 were analyzed retrospectively. This Biodesign Surgisis patch for incisional hernia is produced by the Cook company in the United States. The size of patch ranged from 9 cm × 15 cm to 20 cm × 25 cm. During operation, according to abdominal wall defect, the patch was cut to ensure the distance from its edge to the border of abdominal wall defect more than 5 cm.

RESULTSThere were four male and tenfemale patients with average age of (67.7±11.6) years and average body mass index(BMI) of (25.5±1.7) kg/m². As for operative history of these 14 cases, 7 cases had gastrointestinal tumor surgery, 2 had appendectomy, 1 had upper abdominal white line hernia repair, 1 had hysterectomy, 1 had cholecystectomy, 1 had splenectomy plus portal vein dissection, and 1 had right kidney and right ureter total resection plus partial excision of bladder wall. Ten casesdeveloped incisional infection after previous surgery. The duration of incisional hernia ranged 1 to 180 months (median, 8 months). Two cases were refractory hernia, 1 was incarcerated hernia, and 11 were reversible hernia. The locations of incisional hernia included 4 cases of right ventral wall, 1 case of left ventral wall, 2 cases of supra-umbilical incision, 4 cases of infra-umbilical midline incision, and 3 cases of peri-umbilical midline incision. There were 3 cases of middle incisional hernia, 5 cases of large incisional hernia and 6 cases of huge incisional hernia. All the patients completed operations eventlessly. The average operative time was (202.5±72.9) minutes. The average length and width of hernia ring were (10.9±4.3) cm and (9.3±3.9) cm, respectively. Clean operation was performed in 11 cases, potential contaminative operation in 2 cases and contaminative operation in 1 case. The amount of operative bleeding was (15.0±4.8) ml. The NRS pain scores within 24 hours after the operation, at POD3 and at POD7 were 5.1±0.9, 4.2±0.7 and 3.7±0.9, respectively. The time to flatus after operation was (2.5±0.9) days and the time to liquid diet was (3.8±1.2) days. No patient died during the perioperative period. The average hospitalization time was (21.5±12.0) days. Postoperative complications occurred in 8 cases, including 4 cases of fever, 8 cases of incision complications, 4 cases of abdominal infection, 4 cases of intestinal obstruction, 5 cases of effusion under patch, 2 cases of pneumonia, and 1 case of acute myocardial infarction. According to the Clavien-Dindo classification, 3 cases were grade zero, 3 cases were grade I(, 6 cases were grade II(, 1 case was grade III(, and 1 case was grade IIII(. Thirteen patients received follow-up and the average follow-up time was (33.2±12.3) (18.2-61.0) months. One patient died of cerebral infarction 38 months after operation. The chronic abdominal pain or discomfort was found in 4 cases. The recurrent incisional hernia developed in 5 cases and the average time of recurrence was (11.0±8.3) months.

CONCLUSIONSBiological patch can be used safely and effectively in hybrid technique for incisional herniorrhaphy. However, the morbidity of postoperative complication and the risk of recurrence are high. Terefore, the long-term outcome is still subject to observation.

Aged ; Animals ; Bioprosthesis ; Female ; Follow-Up Studies ; Hernia, Ventral ; surgery ; Herniorrhaphy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Mesh ; Swine

Objective To assess the association of single nucleotide polymorphisms (SNPs)of biliverdin reductase A (BLVRA) with neonatal hyperbilirubinemia from Fujian area.Methods A total of 286 patients with neonatal hyperbilirubinemia and 250 healthy controls were enrolled.Genotypes of 5 SNPs within BLVRA gene including rs699512,rs1802846,rs7738,rs1637530 and rs2302032 were determined with matrix-assisted laser desorption ionization/time of flight mass spectrometer.The frequencies of genotype,allele,haplotype and their differentiations were analyzed.Results All 5 SNPs had conformed to Hardy-Weinberg equilibrium (all P ＞ 0.05).rs699512 and rs1637530 showed a significant difference between the 2 groups in both allelic and genotypic frequencies (all P ＜ 0.05),but no significant differences were found in the other SNPs(all P ＞ O.05).In recessive model,the frequency of rs699512 GG genotype of patients was significantly lower than that of the healthy control group(OR =0.494,95％ CI:0.276-0.886,P =0.018),while in dominant model,the frequencies of rs699512 GG + AG and rs1637530 TT + CT genotype of patients were significantly lower than that of the healthy control group(OR =0.678,0.627;95％ CI:0.482-0.954,0.444-0.885;P =0.026,0.008).Based on linkage disequilibrium analysis and haplotype construction,rs1637530,rs2302032,rs699512 and rs1802846 locus in the same area.Based on haplotype CGAT,TGGT,CTAT and CGGT had significant differences between the 2 groups (all P ＜ 0.05),and could reduce the risk of high blood bilirubin (OR =0.588,0.687,0.501;95％ CI:0.434-0.797,0.496-0.952,0.250-1.004).Conclusions rs699512 and rs1637530 may be associated with neonatal hyperbilirubinemia,A allele in rs699512 and C allele in rs1637530 may be associated with significantly increased risk of neonatal hyperbilirubinemia.

OBJECTIVETo explore clinical features and mutation types in patients from Fujian area with glutaric academia type I(GA I).

METHODSSerum acylcarnitine and urine organic acid of 3 patients were determined with tandem mass spectrometry and gas chromatographic mass spectrometry. The patients also underwent magnetic resonance imaging analysis for the cranial region. Genomic DNA was extracted from peripheral blood samples, and the 12 exons and flanking regions of the GCDH gene were amplified with PCR and subjected to direct DNA sequencing. One hundred healthy newborns were used as controls.

RESULTSMutations of the GCDH gene were identified in all of the 3 patients. Two patients have carried compound heterozygous mutations including c.1244-2A>C and c.1147C>T(p.R383C), c.406G>T(p.G136C) and c.1169G>A(p.G390E), respectively. One has carried homozygous c.1244-2A>C mutation. The same mutations were not detected among the 100 healthy newborns. Only one patient received early intervention and did not develop the disease. The other two had irreversible damagesto their intelligence.

CONCLUSIONc.1169G>A(p.G390E) is likely pathogenic mutations for GA I patients from Fujianarea. Early screening of neonatal metabolic diseases is crucial for such patients.