Objective:To analyze the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy combined with papillary muscle balloon dilation (PTBL-PBD) in the treatment of refractory common bile duct (CBD) stones.Methods:Clinical data of eight patients with CBD stones who underwent PBD treatment in the Department of Interventional and Vascular Surgery of Wanning People's Hospital from March 2023 to October 2024 were retrospectively collected, including seven males and one female, aged 71.6±6.9 years. Under local anesthesia, a passage was established through percutaneous transhepatic biliary puncture, combined with holmium laser lithotripsy and balloon lithotripsy. Two weeks after the operation, angiography was performed to evaluate the therapeutic effect. Bile culture of bacteria were collected from the patients. Symptoms including fever, jaundice, abdominal pain and complications of the patients after the operation were recorded. The white blood cell (WBC) count, hypersensitive C-reactive protein (CRP), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) one week before and one week after the operation were analyzed. All patients were followed up.Results:Eight patients successfully completed the surgery. No residual stone in the biliary system were observed in the imaging two weeks after the operation in six of the patients, and the biliary drainage tubes were successfully removed. Residual stone were observed in two of the patients, which were completely removed through re-treatment with balloon lithotripsy. Biliary bacterial infection occurred in four cases after the operation, including three cases with Escherichia coli and one with Klebsiella pneumoniae. One case with postoperative biliary hemorrhage was managed with coil embolization for hemostasis. The symptoms such as fever, jaundice and abdominal pain of the patients were all relieved after the operation. The WBC count decreased from 14.3±2.8 ×10 9/L before the operation to 6.1±1.3 ×10 9/L, and the high-sensitivity CRP decreased from 58.7±15.2 mg/L to 8.4±3.6 mg/L. Total bilirubin decreased from 102.2±27.7 μmol/L to 17.6±5.5 μmol/L, AST decreased from 137.6±36.7 U/L to 30.4±9.9 U/L, and ALT decreased from 141.3±44.9 U/L to 32.4±10.8 U/L. Two patients were followed up for 24 months, five for 12 months, and one for 6 months. No long-term complications such as stone recurrence or bile duct stenosis were observed during the follow-ups, and there were no clinical symptoms such as fever, jaundice, or abdominal pain. Conclusion:The treatment of refractory common bile duct stones with PTBL-PBD has less trauma and high safety, and could be suitable for high-risk patients who have failed with endoscopic approaches or cannot tolerate general anesthesia.

Objective:To analyze the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy combined with papillary muscle balloon dilation (PTBL-PBD) in the treatment of refractory common bile duct (CBD) stones.Methods:Clinical data of eight patients with CBD stones who underwent PBD treatment in the Department of Interventional and Vascular Surgery of Wanning People's Hospital from March 2023 to October 2024 were retrospectively collected, including seven males and one female, aged 71.6±6.9 years. Under local anesthesia, a passage was established through percutaneous transhepatic biliary puncture, combined with holmium laser lithotripsy and balloon lithotripsy. Two weeks after the operation, angiography was performed to evaluate the therapeutic effect. Bile culture of bacteria were collected from the patients. Symptoms including fever, jaundice, abdominal pain and complications of the patients after the operation were recorded. The white blood cell (WBC) count, hypersensitive C-reactive protein (CRP), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) one week before and one week after the operation were analyzed. All patients were followed up.Results:Eight patients successfully completed the surgery. No residual stone in the biliary system were observed in the imaging two weeks after the operation in six of the patients, and the biliary drainage tubes were successfully removed. Residual stone were observed in two of the patients, which were completely removed through re-treatment with balloon lithotripsy. Biliary bacterial infection occurred in four cases after the operation, including three cases with Escherichia coli and one with Klebsiella pneumoniae. One case with postoperative biliary hemorrhage was managed with coil embolization for hemostasis. The symptoms such as fever, jaundice and abdominal pain of the patients were all relieved after the operation. The WBC count decreased from 14.3±2.8 ×10 9/L before the operation to 6.1±1.3 ×10 9/L, and the high-sensitivity CRP decreased from 58.7±15.2 mg/L to 8.4±3.6 mg/L. Total bilirubin decreased from 102.2±27.7 μmol/L to 17.6±5.5 μmol/L, AST decreased from 137.6±36.7 U/L to 30.4±9.9 U/L, and ALT decreased from 141.3±44.9 U/L to 32.4±10.8 U/L. Two patients were followed up for 24 months, five for 12 months, and one for 6 months. No long-term complications such as stone recurrence or bile duct stenosis were observed during the follow-ups, and there were no clinical symptoms such as fever, jaundice, or abdominal pain. Conclusion:The treatment of refractory common bile duct stones with PTBL-PBD has less trauma and high safety, and could be suitable for high-risk patients who have failed with endoscopic approaches or cannot tolerate general anesthesia.

Background::The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE.Methods::In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results::The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P = 0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243–5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056–5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792–30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467–8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288–36.484) were independently associated with elevated hs-cTnI. Conclusions::CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:Verstaile free superficial circumflex iliac artery perforator flap(SCIAPF) were adopted for various reconstructive scenarios, and its clinical effect and value was evaluated.Methods:Retrospective analysis was performed on 42 patients with tissue defects admitted in the Department of Orthopeadic of the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to May 2019. Nine patients had injury in the foot, 8 in ankle, 8 in calf, 7 in forearm, 9 in hand, and 1 in the mouth. All of the defects were repaired by SCIAPF, including 28 single soft tissue defect wounds, 8 multiple soft tissue defect, and 6 composite defects. The size of soft tissue defect were 1.2 cm×1.8 cm-14.0 cm×20.8 cm. The size of flaps were 1.5 cm×2.0 cm-15.3 cm×22.3 cm. The patients entered follow up by outpatient clinic visit and telephone reviews to observe the survival of the flaps, functional recovery and complications.Results:In this series, there were 28 flaps, including 18 pedicled with superficia branch of superficial circumflex iliac artery, 2 pedicled with deep branch of superficial circumflex iliac artery, and 8 pedicled with 2 branches. Six were chimeric flaps. Among them, 4 flaps were iliac bone flaps with superficial branch of superficial circumflex iliac artery flaps, and 2 were superficial iliac circumflex artery flap with sartorius muscle flap. Eight cases were resurfaced with lobulated SCIAPF. Arterial anastomoses: end-to-side in 35 arteries and end-to-end in 7 arteries. Venous anastomosis: end-to-end in 27 veins and end-to-side in 15 veins. Venous return through superficial iliac circumflex vein in 25 flaps, through venae comitantes in 12 flaps and through both in 5 flaps. All flap donor sites were sutured directly. All flaps survived uneventfully except for one that compromised with end-to-side anastomotic dehiscence and bleeding, and survived after re-anastomosis. All flaps and donor sites healed primarily. During the follow-up of 6-24(mean, 11.5) months, the pliable flaps were ruddy in colour and soft in texture, without obvious bloatness and pigmentation. The donor site healed well with linear scars in 35 cases and mild scar hyperplasia in 7 cases. The donor hip function were normal. Three patients suffered a numbness of the thigh caused by intraoperative injury lateral femoral cutaneous nerve and it disappeared completely after 3 months.Conclusion:New applications of lobulated or chimeric SCIAPF, based on the SCIA vasculature or its branches, can meet most of the clinical repair requirement.

Objective: To analyze the association between masculine and feminine traits, gender role in students and family factors, and to provide a scientific basis for promoting the healthy development of children and adolescents gender role. Methods: Cluster random sampling method was used to selected 823 students from 2 schools of Xiamen in May, 2018, participants were asked to report individual masculine and feminine traits through the Child s Sex Role Inventory, and then gender role was divided into four types (masculine, feminine, androgynous, undifferentiated). Non parametric tests, generalized linear model, and Logistic regression model were used to explore the association between masculine and feminine traits, gender role and family factors. Results: Compared with the boys from the nuclear family, the masculine traits were lower in boys of other families by 0.282( 95% CI = -0.452 --0.110), and the feminine traits were also lower by 0.192 (95% CI =-0.369--0.014). Compared with boys of middle socioeconomic status (SES), the masculine traits of boys from low SES decreased by 0.157 (95% CI =-0.286--0.029), and the feminine traits decreased by 0.140 (95% CI =-0.274--0.005). The proportion of androgynous in boys from other families was significantly lower than boys from the nuclear family ( OR =0.45, 95% CI =0.21-0.94), with the proportion of undifferentiated significantly higher than nuclear family 2.33 (95% CI =1.22-4.44). The proportion of androgynous in boys from low SES was significantly lower than boys from middle SES ( OR =0.59, 95% CI =0.35-0.99), with the proportion of undifferentiated significantly higher than middle SES 1.62 (95% CI =1.00-2.65). Among girls, the differences in masculine and feminine traits and gender role of different family factors were not statistically significant ( P >0.05). Conclusion The masculine and feminine traits and gender role in students are associated with family structures and socioeconomic status, especially in boys. Therefore, the family environment is an important factor affecting children s gender role, and the healthy development of children s gender role needs parents attention and correct guidance.

Objective: To analyze the correlation between the scores of masculinity and femininity and parental rearing pattern in lower grade primary school students in Xiamen, and to provide a policy suggestions and reference basis for establishing a correct concept of gender role among children and adolescents. Methods: A cluster random sampling method was used to select 823 students from two primary schools in Xiamen. Masculinity and femininity scores were assessed by Children s Sex Role Inventory(CSRI), while attitudes and behaviors of parental rearing pattern were obtained through EMBU. Regression analyses were used to analyze the correlation between masculinity and femininity scores and parental rearing pattern. Results: Masculinity scored 2.82 ( 2.41 ,3.24) and 2.82 (2.47,3.18), femininity scored 2.87 (2.40,3.20) and 3.13 (2.73,3.47) among boys and girls, with no significant gender difference ( P >0.05). Masculinity and femininity scores varied significantly by parental emotional warmth and understanding(father: Z/H =44.61, 37.24；mother: Z/H=41.68, 46.64, P <0.05). Among boys, increasing parental emotional warmth and understanding and paternal excessive interference were associated with higher masculinity and femininity scores. Increasing rejection and maternal deny were associated with lower masculinity scores. Among girls, increasing the understanding of emotional warmth of fathers was associated with masculinity and femininity scores, increasing excessive interference from mothers was associated with lower masculinity scores ( P <0.05). Conclusion There are gender differences in the relationship between parental rearing pattern and masculinity and femininity scores. In particular, increasing parents emotional warmth and understanding and reducing mothers punishment and harshness, rejection and denial, and other negative parenting styles could facilitate healthy development of masculinity and femininity among primary school students.

Objective::Cardiac damage is commonly reported in patients with coronavirus disease 2019 (COVID-19) but its prevalence and impact on the long-term survival of patients remain uncertain. This study aimed to explore the prevalence of myocardial injury and assess its prognostic value in patients with COVID-19.Methods::A single-center, retrospective cohort study was performed at the Affiliated Hospital of Jianghan University. Data from 766 patients with confirmed COVID-19 who were hospitalized from December 27, 2019 to April 25, 2020 were collected. Demographic, clinical, laboratory, electrocardiogram, treatment data and all-cause mortality during follow-up were collected and analyzed.Results::Of the 766 patients with moderate to critically ill COVID-19, 86 (11.2%) died after a mean follow-up of 72.8 days. Myocardial injury occurred in 94 (12.3%) patients. The mortality rate was 64.9% (61/94) and 3.7% (25/672) in patients with and without myocardial injury, respectively. Cox regression showed that myocardial injury was an independent risk factor for mortality (hazard ratio: 8.76, 95% confidence interval: 4.76-16.11, P < 0.001). Of the 90 patients with myocardial injury with electrocardiogram results, sinus tachycardia was present in 29, bundle branch block in 26, low voltage in 10, and abnormal T-wave in 53. Conclusions::COVID-19 not only involves pneumonia but also cardiac damage. Myocardial injury is a common complication and an independent risk factor for mortality in COVID-19 patients.

Objective::Cardiac damage is commonly reported in patients with coronavirus disease 2019 (COVID-19) but its prevalence and impact on the long-term survival of patients remain uncertain. This study aimed to explore the prevalence of myocardial injury and assess its prognostic value in patients with COVID-19.Methods::A single-center, retrospective cohort study was performed at the Affiliated Hospital of Jianghan University. Data from 766 patients with confirmed COVID-19 who were hospitalized from December 27, 2019 to April 25, 2020 were collected. Demographic, clinical, laboratory, electrocardiogram, treatment data and all-cause mortality during follow-up were collected and analyzed.Results::Of the 766 patients with moderate to critically ill COVID-19, 86 (11.2%) died after a mean follow-up of 72.8 days. Myocardial injury occurred in 94 (12.3%) patients. The mortality rate was 64.9% (61/94) and 3.7% (25/672) in patients with and without myocardial injury, respectively. Cox regression showed that myocardial injury was an independent risk factor for mortality (hazard ratio: 8.76, 95% confidence interval: 4.76-16.11, P < 0.001). Of the 90 patients with myocardial injury with electrocardiogram results, sinus tachycardia was present in 29, bundle branch block in 26, low voltage in 10, and abnormal T-wave in 53. Conclusions::COVID-19 not only involves pneumonia but also cardiac damage. Myocardial injury is a common complication and an independent risk factor for mortality in COVID-19 patients.

Objective: To investigate the association between the combined effect of height growth and overweight/obesity with elevated blood pressure in Chinese children. Methods: Based on a cohort study of puberty development in Xiamen, a cluster sampling method was used to select 1 313 children whose complete height, weight and blood pressure levels at baseline were obtained in 2017 and during a follow up in 2019. The incidence of elevated blood pressure was compared between four different subgroups, and multivariate Logistic regression was performed to analyze the combined effect in boys and girls. Results: Among 1 313 children, the prevalence of elevated blood pressure at baseline was 25.2%. After 2 years of follow up, the incidence of elevated blood pressure was 19.7% and 23.4% in boys, and 16.6% in girls. After adjusting for factors including age, sex, family history of hypertension, sleep time, intake of fruits, vegetables, sugar sweetened beverages, and meat products, multivariate Logistic regression analyses showed that children in the high height growth and overweight/obesity group were more likely to exhibit a higher incidence of elevated blood pressure (overall:RR=2.41，95%CI=1.44-4.04；boys：RR=2.69，95%CI=1.45-5.02). Among girls, the risk of elevated blood pressure in the low height growth and overweight/obesity group also increased significantly (RR=4.47, 95%CI=1.45-13.75). Conclusion A large magnitude of height growth and being overweight/obesity were associated with elevated blood pressure in children, especially boys. Therefore, interventions that are targeted toward obesity prevention in children before pubertal growth spurts in height may be beneficial to reduce childhood high blood pressure.