Objective:To elucidate the spatial distribution patterns of the right hepatic vein by analyzing the image information obtained after CT three-dimension reconstruction of liver to provide guidance in surgical planning of anatomical hepatectomy.Methods:A retrospective analysis was performed on the clinical data of 77 subjects who underwent CT examination of the liver at the Second Affiliated Hospital of Harbin Medical University from September 2018 to October 2021. There were 42 males and 35 females, aged (50.2±12.8) years old. CT DICOM data of the patients were collected, and the two-dimensional image data were reconstructed into a three-dimensional model by using the 3D reconstruction software. The characteristics and typing were studied by analyzing the number of branches of the right hepatic vein and the spatial location of the main trunk.Results:Of 77 subjects, 645 branches of the right hepatic vein were observed in the liver CT 3D reconstruction model, including 268 (41.6%) right-sided branches, 240 (37.2%) dorsal branches, 70 (10.9%) left-sided branches, and 67 (10.3%) ventral branches. Each right hepatic vein possessed 3 (3, 4) right-sided branches, 3 (3, 4) dorsal branches, 1 (0, 1) left-sided branch, and 1 (0, 1) ventral branch. The numbers of branches in the four directions were significantly different ( H=175.89, P<0.001). Comparison showed that the number of right-sided branches was significantly more than that of the left-sided (χ 2=136.86) and ventral (χ 2=140.07), respectively. The number of dorsal branches was more than that of left-sided (χ 2=-123.36) and ventral (χ 2=126.57) branches, respectively. The differences were significant ( P<0.001). There were no significant differences between the number of ventral and left-sided branches, and between the dorsal and right-sided branches (all P>0.05). Conclusion:The right hepatic vein had fewer ventral and left-sided branches. It is relatively safe to dissect the right hepatic vein from the ventral or the left side during surgery. For resection of the central liver segments or segment VIII of the liver, it is reasonable to transect the liver along the left border of the right hepatic vein.

Objective:To investigate the predictors of clinically important stress-related gastrointestinal bleeding (CIS-GIB) after acute stroke and their impact on short-term outcome.Methods:Consecutive acute stroke patients diagnosed as stress ulcer (SU) and admitted to Beijing Friendship Hospital from January 1, 2016 to January 1, 2020 were enrolled retrospectively. The primary outcome event was CIS-GIB and was defined as dominant gastrointestinal bleeding and corresponding clinical manifestations occurred within 24 h after bleeding. The second outcome event was the short-term clinical outcome assessed by the modified Rankin Scale score at 14 d after onset, and ≤2 was defined as a good outcome. Multivariate logistic regression model was used to analyze the independent influencing factors of CIS-GIB and short-term outcome. Results:A total of 96 patients with post-stroke SU were included, accounting for 2.5% (96/3 819) of all patients with acute stroke; among them, 16 patients (16.7%) developed CIS-GIB, accounting for 0.4% (16/3 819) of all patients with acute stroke. Among the included patients, there were 27 women (29.2%), with a median age of 70 years (interquartile range, 62-79 years). The median National Institutes of Health Stroke Scale (NIHSS) score was 8 (interquartile range, 3-17), and a median time interval between SU and the index stroke event was 2 d (interquartile range, 1-5 days). Compared with the non-CIS-GIB group, the baseline NIHSS score and the proportion of patients with supratentorial stroke were higher, the time interval between SU and the index stroke event was longer, the proportion of patients with coagulation dysfunction, using nasogastric tube and ventilator, receiving gastrointestinal invasive hemostasis and erythrocyte component transfusion were higher, and the risks of poor outcome and death were higher in the CIS-GIB group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio [ OR] 1.146, 95% confidence interval [ CI] 1.029-1.275; P=0.013), glycosylated hemoglobin ( OR 1.567, 95% CI 1.025-2.395; P=0.038), history of chronic gastric diseases ( OR 24.900, 95% CI 1.446-428.728; P=0.027), supratentorial stroke ( OR 5.701, 95% CI 1.002-32.443; P=0.050) and activated partial thromboplastin time ≥34.0 s ( OR 11.036, 95% CI 1.154-105.560; P=0.037) were the independent risk factors for CIS-GIB; the baseline NIHSS score was an independent influencing factor for poor outcome ( OR 1.366, 95% CI 1.029-1.812; P=0.031). Conclusion:The incidence of CIS-GIB in patients with acute stroke is about 0.4%, which significantly increases the risk of short-term adverse outcome. High glycosylated hemoglobin level, prolonged activated partial thromboplastin time, high baseline NIHSS score, supratentorial stroke and history of chronic gastric diseases are the independent risk factors for CIS-GIB.

BACKGROUND: Decreased heart rate variability (HRV) is a predictor of autonomic system dysfunction, and is considered as a potential mechanism of increased risk of cardiovascular disease (CVD) induced by exposure to particulate matter less than 2.5 μm in diameter (PM METHODS: An updated systematic review and meta-analysis of panel studies till November 1, 2019 was conducted to evaluate the acute effect of exposure to ambient PM RESULTS: A total of 33 panel studies were included in our meta-analysis, with 16 studies conducted in North America, 12 studies in Asia, and 5 studies in Europe. The pooled results showed a 10 μg/m CONCLUSION Short-term exposure to PM
Adult ; Aged ; Aged, 80 and over ; Air Pollutants/analysis* ; Air Pollution/analysis* ; Female ; Heart Rate/drug effects* ; Humans ; Male ; Middle Aged ; Particulate Matter/analysis* ; Young Adult

Objective:To quantitatively evaluate the change of the long axis angle and the relative displacement of the crown feature points of the posterior teeth under normal bite force utilizing an intraoral scanner, and to provide clinical reference.Methods:From May to December 2019, fifteen graduate volunteers (5 males and 10 females, aged from 22 to 30, with an average age of 25.7 years) from Peking University School and Hospital of Stomatology were recruited to participate in the study. The surface data (U1, L1) of the maxillary and mandibular posterior teeth were scanned by an intraoral scanner i500, and saved as original data. The volunteers were guided to bite in the intercuspal position with normal bite force. The buccal bite data of the posterior teeth were scanned as the basis for registration. The digital casts were imported into Geomagic studio 2013 software and the boundary lines along the gingival margin and mesial and distal contact area of posterior teeth of data (U1, L1) were determined. Long axis of the crown, crown centroid and mesial functional cusp vertex were establishd. The data (U1, L1) were segmented into single tooth. Single tooth was aligned to buccal bite data separately using best-fit alignment command based on the buccal common area of the crown and new casts data (U2, L2) were obtained as the data under bite force. The long axis angle and centroid distance between adjacent teeth (second premolar and first molar, second molar and first molar) were measured and the deviation between data obtained at mouth-open state and that at biting state was calculated. Negative value meant centroid distance became shorter under bite force. The first molar was set as the common area and registrate the U1, L1 to U2, L2. The angle of long axes, and displacement of centroid and of functional cusp vertex between second premolar of two casts were calculated, as well as between second molar of two casts. Wilcoxon signed rank test was used to analyze the differences of teeth displacement between second premolar and second molar, and between maxillary and mandibular jaws with SPSS 26.0 statistical software.Results:The result of second premolar and second molar in the same jaw had no statistical difference ( P>0.05). The centroid distance deviation of mandibular second premolar-first molar [-0.022(0.046) mm] was larger than that of maxilla [-0.006 (0.040) mm] ( P<0.05). The long axis angle of second premolar itself [0.913°(0.647°)] and centroid distance of second molar itself [0.102 (0.106) mm] on the mandibular jaw were different from that on the maxillary jaw, which were 0.590°(0.550°) and 0.074(0.060) mm respectively ( P<0.05). Conclusions:Under bite force, displacement of the second premolar and second molar was present, including the displacement of centroids and deflection of long axes. The mandibular posterior teeth have larger displacement than the maxillary teeth.

Objective: To assess the incidence and independent risk factors for clinical anastomotic leakage (AL) in patients undergoing anterior resection (AR) or low anterior resection, (LAR) for rectal cancer. Methods: This was a retrospective case-control study of 550 patients with rectal cancer who underwent AR or LAR from April 2007 to March 2017 in Beijing Friendship Hospital, Capital Medical University. The relationship between the incidence of AL and clinicopathological manifestations was analyzed by Chi-squared test and Fisher exact test, and the independent risk factors of AL were analyzed using logistic regression analysis. AL is defined as a defect (including necrosis or abscess formation) of the intestinal wall at the anastomotic site, leading to a communication between the intra- and extra-luminal compartments. AL can be divided into three grades. Grade A anastomotic leakage results in no change in the management of patients, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy. Results: AL was noted in 32 (5.8%) of 550 patients with rectal cancer who underwent AR or LAR, including 15 (46.9%) , 4 (12.5%) , and 13 patients (40.6%) with Grades A, B, and C, respectively. Five patients (0.9%, 5/550) died peri-operatively. AL- and non-AL-related deaths occurred in 3 (9.4%, 3/32, all cases were Grade C) and 2 patients (0.4%, 2/518) , respectively, with the two mortality rates being significant difference (P = 0.002) . Chi-squared test or Fisher exact test showed that the incidence of AL was associated with neoadjuvant chemoradiotherapy (P = 0.011) , intraoperative bleeding (≥100 ml) (χ² = 11.980, P = 0.001) , and tension-reducing suture of anastomosis (P = 0.015) . The results of logistic regression analysis showed that the independent risk factors of AL were neoadjuvant chemoradiotherapy (OR = 2.402, 95%CI: 1.004 - 5.749, P = 0.049) , intraoperative bleeding (≥100 ml) (OR = 2.971, 95%CI: 1.269 - 6.957, P = 0.012) and tension-reducing suture of anastomosis (OR = 2.304, 95%CI: 1.008 - 5.263, P = 0.048) . Conclusion The incidence of AL in patients undergoing AR for rectal cancer is 5.8%. The high-risk factors for AL are neoadjuvant chemoradiotherapy, intraoperative bleeding (≥100 ml) , and tension-reducing suture of anastomosis. Patients with these three risk factors have a high risk of AL rate, and a defunctioning stoma should be performed.

PURPOSE: Research has shown that sevoflurane-induced toxicity causes neurodegeneration in the developing brain. miR-34a has been found to negatively regulate ketamine-induced hippocampal apoptosis and memory impairment. However, the role of miR-34a in sevoflurane-induced hippocampal neurodegeneration remains largely unclear. MATERIALS AND METHODS: C57/BL6 mice (7-day-old) inhaled 2.3% sevoflurane for 2 h/day over 3 consecutive days. miR-34a expression was reduced through intracerebroventricular injection with miR-34a interference lentivirus vector (LV-anti-miR-34a) into mouse hippocampus after anesthesia on the first day of exposure. Hippocampal apoptosis was detected by TUNEL assay and flow cytometry analysis. Spatial memory ability was evaluated by the Morris water maze test. The interaction between miR-34a and Wnt1 was confirmed by luciferase reporter assay, RNA immunoprecipitation, Western blot, and immunofluorescence staining. The effects of miR-34a on protein levels of B-cell lymphoma 2 (Bcl-2), bcl-2-like protein 4 (Bax), and Wnt/β-catenin pathway-related proteins were evaluated using Western blot analysis. RESULTS: Sevoflurane upregulated hippocampal miR-34a, and miR-34a inhibitor attenuated sevoflurane-induced hippocampal apoptosis and memory impairment. miR-34a negatively regulated Wnt1 expression by targeting miR-34a in hippocampal neurons. Moreover, forced expression of Wnt1 markedly undermined miR-34a-mediated enhancement of sevoflurane-induced apoptosis of hippocampal neurons, while Wnt1 silencing greatly restored anti-miR-34a-mediated repression of sevoflurane-induced apoptosis of hippocampal neurons. Increased expression of miR-34a inhibited the Wnt/β-catenin pathway in hippocampal neurons exposed to sevoflurane, while anti-miR-34a exerted the opposite effects. CONCLUSION: miR-34a inhibitor may effectively protect against sevoflurane-induced hippocampal apoptosis via activation of the Wnt/β-catenin pathway by targeting Wnt1.
Anesthesia ; Animals ; Apoptosis* ; Blotting, Western ; Brain ; Flow Cytometry ; Fluorescent Antibody Technique ; Hippocampus ; Immunoprecipitation ; In Situ Nick-End Labeling ; Lentivirus ; Luciferases ; Lymphoma, B-Cell ; Memory ; Mice ; Neurons ; Repression, Psychology ; RNA ; Spatial Memory ; Water

In the process of medical service, there are several apparent links such as medical etiquette, doctor-patient psychological protecting wall, and early intervention to patients′emotion, medical ethics and patient ethics, the principle of no harm, palliative care and doctor virtues. This article analyzes and discusses these apparent links in detail.

BACKGROUND:Biomechanical compatibility is the necessary condition to ensure the stable osseointegration with implants that then can function over a long period; therefore, it is especialy important to get knowledge about distribution of stress and strain between the maxilary central incisor and its surrounding bone tissue. OBJECTIVE: Based on five different anatomical types of natural teeth, to study the regularity of stress distribution between the maxilary central incisor root and implant.METHODS: According to the five different anatomical types of natural maxilary central incisors, UGNX and ANSYS were used to set up three-dimensional finite element models (B1, B2, M1, M2, P1) for the implant and surrounding structures, which were under 100 N static load at angles of 0o, 30o, 45o, 60o, 90o with the long axis of teeth. Then, the stress distribution between the five kinds of maxilary central incisor roots and implants was analyzed. RESULTS AND CONCLUSION:Among the five different anatomical types, the equivalent stress for both the natural central incisor and implant were increased with the increasing of angles, and the implant had a higher raising trend. The equivalent stress for the natural tooth concentrated upon B1 for the maximum value and M1 for the minimum value; while the equivalent stress for the implant focused on the maximum value at M1 and the minimum value at M2. There was a gap of 2%-31% between the equivalent stresses for the natural tooth roots and a gap of 4%-21% for the implants. The stress distribution range for the implant was just smaler than that for the natural tooth roots. It implies that the bit force of implant and natural tooth is in positive proportion to the bite angles, and the bite force that implant can burden is smaler than that the central incisor can.

Objective In this article we evaluated the sensitivities and specificities of real-time PCR assay for diagnosis of human brucellosis.Methods The species selectivity and specificity of real-time PCR were evaluated by direct amplification of a 169 bp portion of bcsp31 gene from 15 Brucella strains and 41 non-Brucella strains.According to the monitoring results of 2012 Harbin brucellosis,17 brucellosis patients and 30 health people were selected to collect their serum samples for assessing the sensitivity of real-time PCR,and additional 30 nonbrucellosis patients serum samples were as controls.Results The species selectivity and specificity of our realtime PCR method were evaluated by using genomic DNA from 15 Brucella strains and 41 non-Brucella strains.There were 11 sera with positive amplification signals among the 17 culture-proven brucellosis patients,the sensitivity was 64.7％(11/17).Whereas,the results of sera from the 60 control patients were all negative,corresponding to a specificity of 100.0％.Conclusion The results indicate that real-time PCR is well suitable for confirmation of brucellosis cases.

Objective To investigate the strategy and efficacy of enteral nutrition support of patients with spontaneous intraventricular hemorrhage-induced coma.Methods 139 patients were randomly divided into study group (treated with enteral nutrition mixed suspension,n =67) and control group (treated with normal full nutritional homogenized product,n =72) with a random number generating software.Enteral nutrition support was administered in 6-48 hours after admission.The total daily intake of enteral nutrition preparation was 1 000 ml (4 186.8 kJ),supplemented by liquid food.Body weight,serum albumin,serum total protein,hemoglobin,lymphocyte count,incidence of infection,level of consciousness and incidence of complications were compared between the two groups.Results In the third week after onset,the serum albumin [(32.1 ± 3.3) g/Lvs.(30.5±2.3) g/L,P=0.041],total protein [(62.2±3.2) g/Lvs.(56.9±2.7) g/L,P=0.039],and hemoglobin [(125.5 ±5.7) g/Lvs.(120.7 ±6.4) g/L,P=0.027] were significantly higher in the study group than in the control group.The Glasgow score in the second week in the study group was 13.1 ± 1.9,significantly higher than that in the control group (11.0 ±2.3) (P =0.037);the incidence of nosocomial infection was significantly lower in the study group than in the control group [17.9％ (12/67) vs.29.2％ (21/72),P =0.021];the proportion of patients with abnormal blood test results and that of patients having fever for more than 7 consecutive days were both significantly lower in the study group than in the control group [31.3％ (21/67) vs.38.8％ (28/72),P=0.042;37.3％ (25/67) vs.41.7％ (30/72),P =0.047].The two groups showed no significant difference in the incidence of intracranial infection after external ventricular drainage (P =0.235).Conclusion For patients with spontaneous intraventricular hemorrhage-induced brain dysfunction,enteral nutrition support with enteral nutrition suspension could effectively improve nutritional status,reduce complications,therefore conducive to recovery.