Objective:To explore the surgical efficacy of high position dacryocystorhinostomy (DCR) under nasal endoscopy in patients with chronic dacryocystitis secondary to failure of nasolacrimal duct stent implantation.Methods:A total of 101 patients with chronic dacryocystitis who were treated at People′s Hospital of Peking University from 2013 to 2024 were retrospectively selected, including 14 males and 87 females, aged (56.82±13.00) years (Mean±SD). The patients were divided into control group (53 cases, 59 eyes) and stent group (48 cases, 60 eyes). The control group consisted of randomly selected patients with simple dacryocystitis, while, the stent group included patients with secondary dacryocystitis after failure of nasolacrimal duct stent implantation. All patients underwent endoscopic high DCR with exposed the Rosenmüller valve, combined with intraoperative lacrimal silicone tube implantation. After the operation, the surgical efficacy was evaluated by methods such as Munk score, endoscopic observation of intranasal ostia, lacrimal duct irrigation, and fluorescein test. SPSS 27.0 software was used for data statistics.Results:All 101 patients were followed up for at least one year after DCR surgery. In the control group, one patient (two eyes) was lost to follow-up; while, in the stent group, three patients (three eyes) were lost to follow-up, with one case diagnosed with lacrimal sac cancer. Excluding the lost-to-follow-up cases and the patient with lacrimal sac cancer, anatomical success was achieved in 54 eyes (96.4%, 54/56) in the stent group, and both anatomical and functional success in 53 eyes (94.6%, 53/56); in the control group, 55 eyes (96.5%, 55/57) achieved both anatomical and functional success. No statistically significant difference was found in postoperative effectiveness efficacy between the two groups ( χ2=0.000, P=0.984). Conclusion:For patients with secondary dacryocystitis after nasolacrimal duct stent implantation, high position DCR with exposure of Rosenmüller valve combined with lacrimal duct silicone intubation can achieve better long-term efficacy.

Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o'clock,of which 76 cases at 10 and 11 o'clock,accounting for 76%;1 case each at 1 and 2 o'clock,accounting for 2%;2 and 4 cases at7 and 8 o'clock respectively,accounting for6%.The inner diameter of the cystic duct ranged from 3 mm to13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or fever,and their liver function was normal.B-ultrasound showed a diameter of 5-10 mm for the common bile duct,with a median of 7 mm,and no postoperative stenosis.Conclusions Exploring the common bile duct through the cystic duct is feasible,with no or minimal damage to the common bile duct and no damage to the Oddi sphincter.It is the best way and surgical technique for laparoscopic exploration and stone removal via choledochoscope in SCL.

Objective:To explore the surgical efficacy of high position dacryocystorhinostomy (DCR) under nasal endoscopy in patients with chronic dacryocystitis secondary to failure of nasolacrimal duct stent implantation.Methods:A total of 101 patients with chronic dacryocystitis who were treated at People′s Hospital of Peking University from 2013 to 2024 were retrospectively selected, including 14 males and 87 females, aged (56.82±13.00) years (Mean±SD). The patients were divided into control group (53 cases, 59 eyes) and stent group (48 cases, 60 eyes). The control group consisted of randomly selected patients with simple dacryocystitis, while, the stent group included patients with secondary dacryocystitis after failure of nasolacrimal duct stent implantation. All patients underwent endoscopic high DCR with exposed the Rosenmüller valve, combined with intraoperative lacrimal silicone tube implantation. After the operation, the surgical efficacy was evaluated by methods such as Munk score, endoscopic observation of intranasal ostia, lacrimal duct irrigation, and fluorescein test. SPSS 27.0 software was used for data statistics.Results:All 101 patients were followed up for at least one year after DCR surgery. In the control group, one patient (two eyes) was lost to follow-up; while, in the stent group, three patients (three eyes) were lost to follow-up, with one case diagnosed with lacrimal sac cancer. Excluding the lost-to-follow-up cases and the patient with lacrimal sac cancer, anatomical success was achieved in 54 eyes (96.4%, 54/56) in the stent group, and both anatomical and functional success in 53 eyes (94.6%, 53/56); in the control group, 55 eyes (96.5%, 55/57) achieved both anatomical and functional success. No statistically significant difference was found in postoperative effectiveness efficacy between the two groups ( χ2=0.000, P=0.984). Conclusion:For patients with secondary dacryocystitis after nasolacrimal duct stent implantation, high position DCR with exposure of Rosenmüller valve combined with lacrimal duct silicone intubation can achieve better long-term efficacy.

Objective To investigate the local anatomical characteristics of the cyctic duct and the feasibility of bile duct exploration through the cystic duct for stone removal and primary suture.Methods From February to September 2023,100 cases of secondary choledocholithiasis(SCL)were treated with laparoscopic transcystic common bile duct exploration(LTCBDE).During the operation,6 indicators were measured,including the direction of the gallbladder duct joining the common bile duct,the inner diameter of the gallbladder duct,the length of the gallbladder duct incision,the length of the gallbladder duct parallel to the common bile duct,the distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum,and the diameter of the stone taken by the cholangioscopy.Results The direction of the gallbladder duct joining into the common bile duct:92 cases at 9-12 o'clock,of which 76 cases at 10 and 11 o'clock,accounting for 76%;1 case each at 1 and 2 o'clock,accounting for 2%;2 and 4 cases at7 and 8 o'clock respectively,accounting for6%.The inner diameter of the cystic duct ranged from 3 mm to13 mm,with a median of 5.0 mm.The length of the common bile duct opened:21 cases(21%)had the common bile duct cut open,with an incision of 1-5 mm and a median of 3.0 mm.The parallel length of gallbladder duct and common bile duct:there was a parallel length of 2-40 mm and a median of 10.0 mm in36 cases.The distance between the incised gallbladder duct or common bile duct and the upper edge of the duodenum was5-20 mm,with a median of 15.0 mm.Intraoperative choledochoscope was used in 90 cases to remove stones,with a total of 128 stones removed.The diameter of the stones ranged from 1.5 mm to 22.0 mm,with a median of 5.0 mm.All the100 cases of LTCBDE were successful.A total of 83 cases(83%)were followed up for 3 months after surgery.After discharge,their appetite returned to normal,and they resumed normal life and work.There were no symptoms of bile duct stones such as abdominal pain,jaundice,or fever,and their liver function was normal.B-ultrasound showed a diameter of 5-10 mm for the common bile duct,with a median of 7 mm,and no postoperative stenosis.Conclusions Exploring the common bile duct through the cystic duct is feasible,with no or minimal damage to the common bile duct and no damage to the Oddi sphincter.It is the best way and surgical technique for laparoscopic exploration and stone removal via choledochoscope in SCL.

Humans ; Air Pollutants/adverse effects* ; Genotype ; China/epidemiology* ; Hypertension/epidemiology*

The extremely low bioavailability of oral paclitaxel (PTX) mainly due to the complicated gastrointestinal environment, the obstruction of intestinal mucus layer and epithelium barrier. Thus, it is of great significance to construct a coordinative delivery system which can overcome multiple intestinal physicochemical obstacles simultaneously. In this work, a high-density PEGylation-based glycocholic acid-decorated micelles (PTX@GNPs) was constructed by a novel polymer, 9-Fluorenylmethoxycarbonyl-polyethylene glycocholic acid (Fmoc-PEG-GCA). The Fmoc motif in this polymer could encapsulate PTX via π‒π stacking to form the core of micelles, and the low molecular weight and non-long hydrophobic chain of Fmoc ensures the high-density of PEG. Based on this versatile and flexible carriers, PTX@GNPs possess mucus trapping escape ability due to the flexible PEG, and excellent intestine epithelium targeting attributed to the high affinity of GCA with apical sodium-dependent bile acid transporter. The in vitro and in vivo results showed that this oral micelle could enhance oral bioavailability of PTX, and exhibited similar antitumor efficacy to Taxol injection via intravenous route. In addition, oral PTX@GNPs administered with lower dosage within shorter interval could increase in vivo retention time of PTX, which supposed to remodel immune microenvironment and enhance oral chemotherapy efficacy by synergistic effect.

Objective: To explore the effects of local transplantation of autologous adipose-derived stromal vascular fraction (SVF) on the hyperplastic scar (HS) formation in rabbit ears and the mechanism. Methods: Twenty-four New Zealand white rabbits were used to reproduce HSs by making four full-thickness skin defect wounds with a diameter of 1 cm on the ventral surface of left ear of each rabbit. Wound epithelization and local-tissue proliferation were observed, and wound healing (complete epithelization) time and formation time of HS were recorded. The 24 rabbits were divided into SVF group, pure DMEM group, and pure HS group according to the random number table, with 8 rabbits and 32 wounds in each group. On post injury day (PID) 25 (after the complete epithelization of wounds), 0.2 mL of low glucose DMEM medium containing CM-Dil labeled autologous SVF was injected into HSs of rabbits in SVF group, while the same amount of low glucose DMEM medium was injected into HSs of rabbits in pure DMEM group. The frequency of injection was once every 5 days, totally for 3 times. HSs of rabbits in pure HS group did not receive any treatment. On PID 40, HSs of rabbits′ ears in each group were harvested, then the histological form was observed by hematoxylin and eosin staining, the arrangement of collagen in HS was observed by Van Gieson staining, the distribution of CM-Dil-labeled SVF in the HS was observed with fluorescence microscope, and the mRNA expression and the protein expression of transforming growth factor β₁ (TGF-β₁), Smad3, and Smad7 in HS were determined by real-time fluorescent quantitative reverse transcription-polymerase chain reaction and Western blotting, respectively. Data were processed with one-way analysis of variance and Tukey test. Results: (1) Complete epithelization time of wounds of rabbits′ ears was (20.0±2.0) d post injury, and HSs were formed on PID 25. On PID 40, HSs of rabbits′ ears in pure DMEM group and pure HS group were still in hyperplasia, while those in SVF group became smaller, flat, soft, and light colored. (2) On PID 40, compared with those in pure DMEM group and pure HS group, the number of epithelium foot like structures was more and the amount of inflammatory cells was less. The collagen of HSs of rabbits′ ears in SVF group was arranged more regularly with broader gap between collagens. (3) On PID 40, CM-Dil-labeled SVF could still be observed in the HSs of rabbits′ ears in SVF group. (4) On PID 40, compared with those in pure DMEM group and pure HS group, the mRNA expressions of TGF-β₁ and Smad3 in the HSs of rabbits′ ears in SVF group were significantly down-regulated (P<0.05), while the mRNA expression of Smad7 was significantly up-regulated (P<0.05). There were no significant differences in the mRNA expressions of TGF-β₁, Smad3, and Smad7 in the HSs of rabbits′ ears between pure DMEM group and pure HS group (P>0.05). (5) On PID 40, compared with those in pure DMEM group (0.74±0.03, 0.73±0.10, 0.54±0.09) and pure HS group (0.72±0.08, 0.71±0.12, 0.53±0.06), the protein expressions of TGF-β₁ and Smad3 in the HSs of rabbits′ ears in SVF group (0.57±0.06, 0.42±0.09) were significantly down-regulated (P<0.05), while the protein expression of Smad7 (0.71±0.05) was significantly up-regulated (P<0.05). The protein expressions of TGF-β₁, Smad3, and Smad7 in the HSs of rabbits′ ears in pure DMEM group and pure HS group were close (P>0.05). Conclusions Autologous SVF transplantation can inhibit the formation of HS in the early stage of scar formation of rabbit, the mechanism may be related to the TGF-β₁/Smad signaling pathway.

Objective To explore the haemostatic efficacy of cervical progressing suture in treating intractable cervical canal hemorrhage during cesarean section(CS) in placenta previa.Methods Sixty patients suffering from intractable cervical canal hemorrhage during CS due to central placenta previa were chosen and divided into the cervical progressing suture(observation roup,30 cases) and the uterine cavity ribbon gauze packing group(control group,30 cases).The intraoperative operating time,intraoperative bleeding amount,postoperative 24 h hemorrhage amount,hysterectomy and puerperal infection were compared between the two groups.Results The intraoperative operation time in the observation group and control group were (3.15± 1.60)min and (6.10±2.35) min respectively,the intraoperative bleeding amount in the observation group and control group were (422.00 ±-186.98)mL and (642.25±344.42)mL respectively,postoperative 24 h bleeding amounts were (583.23±=198.33)mL and (825.23±=373.50)mL respectively,the differences between the two groups were statistically significant(P＜0.05).No hysterectomy and no complications ocurred in each group.Conclusion Adopting the cervical progressing suture in treating intractable cervical canal hemorrhage during cesarean section(CS) due to placenta previa is simple to operate and has good effect.

Objective To investigate characteristics of symptoms, tongue and pulse of high-risk group of stroke, and provide evidence of differential treatment for stroke prevention, diagnosis and treatment of stroke, thus laying a solid foundation on further study of differential treatment system of high-risk groups of stroke. Methods With prospective observational method, 2536 cases of stroke were selected by multi-center screening, and characteristics of TCM symptoms, tongue, pulse and syndrome distribution in different gender and age were observed. Results The top five symptoms were:blurred vision (1670 cases, 65.9%), irritability (1458 cases, 57.5%), limp or pain on waist and knees (1445 cases, 57.1%), dizziness (1286 cases, 50.7%) and dry eyes (1274 cases, 50.2%). The top five tongue and pulse were:white moss (1401 cases, 55.2%), thin moss (1260 cases, 49.7%), string pulse (1201 cases, 47.4%), dark tongue (1168 cases, 46.1%) and red tongue (1027 cases, 40.5%). The detection rate of dizziness, insomnia, white coating, thin coating, etc. were higer in women than that in man (P<0.01). The detection rate of teeth shaking, greasy fur, yellow fur, string pulse, etc. were higher in man than that in woman (P<0.01). The detection rate of teeth shaking, dry eyes, thirst, dark tongue, red tongue, string pulse, etc. in the elderly group were higher than the middle-aged one (P<0.01). The detection rate of irritability, numbness, shortness of breath, scalloped tongue, thin coating, deep pulse, etc. in the middle-aged group was higher than the aged one (P<0.01). Conclusion The clinical manifestations of high-risk group of stroke are complicated. There were root deficiency such as deficiency of spleen and kidney, and branch excess such as wind-fire and phlegm-stasis. Difference and regularity were showed in different gender and different age groups to some extent.

Objective To investigate the drinking water quality of secondary water supply in Tongzhou District, Beijing in order to establish a data monitoring management system. Methods The uniform questionnaires were used for the on-the-spot investigation at secondary water supply units in the whole district, which included secondary water supply facility situations, environmental sanitary conditions and health management and so on. At the same time, municipal water and secondary supply water were tested. Results 48 units of secondary water supply were investigated. In this investigation, the main systems of secondary water supply were the low water tank added frequency conversion pump(accounts for 77.1%) and the inverter constant pressure water supply system with negative pressure(accounts for 14.3%). According to the hygienic requirements, the unqualified rate of water tank structure, disinfection facility and water tank room were 81.0%, 73.3% and 87.3% respectively; besides, 39.6% of the units used the invalid hygienic licenses, 43.5% of the water managers had no health certificates, and 54.5% of the units had never cleaned their water tanks. The total qualification rate of the secondary water supply was 66.7%. The main items that were not up to the standard were ammonia-nitrogen, free chlorine, recognizable objects with naked eyes, total bacteria count and turbidity. For the different water material, the qualification rate showed a significant difference(P=0.023). Conclusion The drinking water quality of the secondary water supply is lower than before and the preventive hygiene supervision and evaluation is comparatively delayed in the investigated district.