Objective:To investigate the clinicopathologic features and differential diagnosis of ureteral fibroepithelial polyps.Methods:The clinicopathologic features and prognosis of ureteral fibroepithelial polyps with complete data retrieved from the pathology database of the Institute of Urology, Peking University from January 2013 to December 2021 were collected and analyzed. All HE staining sections were reviewed by a senior urologic pathologist. Immunohistochemical analysis was done in some cases for differential diagnosis. The clinical, imaging and outcome data were collected, and discussed together with relevant literature.Results:There were 45 patients with complete clinicopathologic data, including 34 males and 11 females (male: female=3.1∶1.0), with a median age of 36 (range 13-80) years. Preoperative diagnosis included polyp in 23 cases, tumor in 19 cases and calculi in 3 cases. The main clinical symptoms were hematuria (13 cases), low back and abdominal pain (9 cases) and no symptoms (9 cases). There were 29 cases of multiple polyps, 16 cases of single polyp; 32 cases were on the left side, 13 cases were on the right side; 29 cases of upper polyps, 9 cases of middle polyps, and 6 cases of lower polyps. Twenty-seven patients had no related urologic history, 10 patients had history of urolithiasis, and the rest had history of stents, strictures or tumors. Local ureteral resection and anastomosis were the most common treatment (20 cases), followed by ureteroscopic polypectomy (12 cases). The patients were followed up from the pathological diagnosis to the cut-off time: 4 cases were lost to follow-up, and the remaining 34 cases were followed up for 3 to 85 (mean 60 months). One case had polyp recurrence after 3 months, and the other case had polyp recurrence after 2 years. Fibroepithelial polyps had a variety of gross manifestations, ranging from elongated polyps or small papillary and polypoid to large papillary masses. Microscopically, they were divided into type 1, type 2 and type 3, and the type 3 was the most common type (28 cases). In this study, there were 41 cases of simple fibroepithelial polyp, 2 cases of malignant transformation of polyps into urothelial carcinoma, one case of polyps with urothelial carcinoma, and one case of polyp with surface urothelial carcinoma in situ; the stroma showed myofibroblastic proliferation.Conclusions:The clinical manifestations and morphologic characteristics of ureteral fibroepithelial polyps are diverse. The three microscopic types are easily confused with many benign and malignant ureteral diseases, such as inflammatory polyps, adenocystitis, papilloma, etc. Awareness of the key differentiation points and judicious use of immunohistochemistry will be helpful for the diagnosis and differential diagnosis.

Objective To understand the public mental health status and related influencing factors during the epidemic of coronavirus disease 2019（COVID-19）. Methods A structured questionnaire was used to conduct a questionnaire survey of the research subjects through an online platform. The public mental health status was assessed using the Symptom Checklist (SCL-90). Logistic regression analysis was used to analyze related influencing factors. Results The survey included 1 078 eligible questionnaires, of which 252 (23.38%) were positive on the SCL-90 scale. For each SCL-90 factor, the highest positive rate was anxiety (41.28%), followed by horror (35.16%), and depression (33.21%). Multivariate logistic regression analysis showed that from Hubei (OR=1.64, P=0.014), male (OR=1.37, P=0.036), medical related occupations or professions (OR=1.57, P=0.008), and high concern over the epidemic (OR=2.19, P=0.013) and known people with suspected or confirmed cases (OR=2.75, P<0.001) were risk factors influencing public mental health. Conclusion The mental health problems of the population during the epidemic of COVID-19 were serious, especially in Hubei. Male groups, medical workers, and people with relatives and friends who have a case need to pay attention to their own mental health. The government should increase the publicity of mental health knowledge to effectively prevent the occurrence and development of mental illness in these people.

Objective To investigate the clinical efficacy and prognostic factors of hepatectomy for hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 789 HCC patients who were admitted to the Sichuan Cancer Hospital Affiliated to School of Medicine of University of Electronic Science and Technology of China from January 2009 to January 2016 were collected.There were 669 males and 120 females,aged from 42 to 60 years,with a median age of 52 years.Surgical procedures were determined according to the preoperative and intraoperative comprehensive evaluations of patients.Observation indicators:(1) situations of surgical treatment;(2) postoperative pathological examinations of patients;(3) follow-up and survival situations;(4) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to May 2017.Normality of measurement data was done using the K-S test.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute number or percentage.The survival rate and survival curve were respectively calculated and drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the Log-rank test and COX regression model,respectively.Results (1) Situations of surgical treatment:all the 789 patients underwent successful hepatectomy,liver volume dissected accounting for 32.5％ (range,17.0％-52.0％) of the total liver volume.Of the 789 patients,413 underwent anatomical hepatectomy including 116 of hepatic segmentectomy,136 of right hemihepatectomy,77 of left hemihepatectomy,57 of left lateral lobe hepatectomy,27 of central hepatectomy,376 underwent nonanatomical hepatectomy including 344 of partial hepatectomy,17 of extended right hemihepatectomy,15 of extended left hemihepatectomy.Volume of intraoperative blood loss was 400 mL (range,200-500 mL) in the 789 patients and 173 had intraoperative blood transfusion.Of the 789 patients,240 had postoperative complications (68 with postoperative severe complications),including 65 of liver insufficiency,37 of ascites and pleural effusion,37 of pulmonary complications,19 of infectious complications,17 of cardiovascular complications,17 of abdominal hemorrhage,11 of gastrointestinal complications,9 of neruologic complications,8 of postoperative bile leakage,10 of other complications,11 of death;the same patient can merge multiple complications.The 229 survival patients with complications were cured by symptomatic supportive treatment.Duration of postoperative hospital stay was 9 days (range,7-11 days).(2) Postoperative pathological examinations.Results of postoperative pathological examinations showed 17 patients with bile duct tumor thrombus,92 with naked eye tumor thrombus at portal vein branches and 167 with microvascular invasion.Of the 789 patients,High-,moderate-,low-differentiated carcinoma were detected in 19,678,92 patients,respectively.(3) Follow-up and survival situations:690 of the 789 patients were followed up for 1-96 months,with a median time of 21 months.The l,3,5-year overall survival rates were 82.1％,66.1％,59.2％ in the 789 patients.(4) Prognostic factors analysis:results of univariate analysis showed that level of preoperative alphafetoprotein (AFP),Child grade of preoperative liver function,Barcelona clinic liver cancer staging,tumor diameter,surgical procedure of hepatectomy,volume of intraoperative blood loss,intraoperative blood transfusion,postoperative complications,postoperative severe complications,bile duct tumor thrombus,portal vein tumor thrombus,vascular invasion were related factors affecting prognosis of HCC patients after hepatectomy (x2 =8.603,8.864,39.970,28.978,6.376,26.144,8.955,6.596,9.910,7.288,37.566,19.183,P＜0.05).Results of multivariate analysis showed that tumor diameter,volume of intraoperative blood loss,portal vein tumor thrombus were independent factors affecting prognosis of HCC patients after hepatectomy (hazard ratio =1.085,1.000,2.259,95％ confidence interval:1.053-1.118,1.000-1.001,1.621-3.146,P＜0.05).Conclusion Hepatectomy for HCC has a good safety,with satisfactory clinical efficacy.Tumor diameter,volume of intraoperative blood loss,portal vein tumor thrombus are independent factors affecting prognosis of HCC patients after hepatectomy.

Objective To review the role of extrahepatic bile duct resection in patients with hepatocellular carcinoma with bile duct tumor thrombi.Methods The Pubmed,Wan Fang and China Science and Technology Journal Database were reviewed systematically.Any case reports or studies involving treatment of hepatocellular carcinoma with bile duct tumor thrombi were included in this literature search.Two authors independently assessed the studies for inclusion and extracted the data.Univariate analysis was used to compare the baseline characteristics and the Kaplan-Meier method was used for analyzing survival and diseasefree survival outcomes.Results Using predetermined inclusion criteria,16 studies which included 170 patients entered into this study.All these patients underwent surgical resection of hepatocellular carcinoma and bile duct tumor thrombi.Based on the Satoh classification,45 patients were type Ⅰ,107 patients type Ⅱ and 18 patients type Ⅲ.Twenty-four patients underwent liver resection combined with extrahepatic bile duct resection.The remaining 146 patients underwent liver resection combined with thrombectomy.The 1-,3-,and 5-year survival rates of all the patients were 73.4％,41.5％ and 21.8％,and the corresponding recurrences free survival rates were 62.5％,29.2％ and 13.1％,respectively.On Kaplan-Meier analysis,there were no significant differences in the survival outcomes between the 2 groups of patients,(P ＞ 0.05).The 1-,3-,and 5-year survival rates of the extrahepatic bile duct resection group were 66.7％,41.7％ and 12.5％,and those of the thrombectomy group were 74.6％,41.3％ and 23.8％,respectively.On subgroup analysis (Satoh type Ⅱ and Ⅲ),no significant differences were observed between the two groups (P ＞0.05).The 1-,3-,and 5-year survival rates of the extrahepatic bile duct resection group were 65.2％,38.0％ and 13.0％,and those of the thrombectomy group were 72.8％,39.5％ and 20.9％,respectively.Conclusion Extrahepatic bile duct resection did not improve the overall survival of patients with hepatocellular carcinoma with bile duct tumor thrombi.

Objective To objectively and standardly compare the bare-handed CPR and Thumper cardiopulmonary resuscitation CPR recovery effect based on cardiopulmonary resuscitation (CPR) Utstein model.Methods A retrospective study was conducted. CPR adult patients admitted to the Emergency Room of First Hospital of Qinhuangdao in Hebei Province from January 2015 to January 2017 were enrolled. Seventy patients who underwent CPR using the Thumper cardiopulmonary resuscitator were included in the Thumper CPR group; 80 patients who underwent manual hand-held CPR were included in the bare-handed CPR group. Return of spontaneous circulation (ROSC) and return of spontaneous breathing, and blood gas analysis indexes of recovery for 5 minutes and 15 minutes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen saturation (SaO2), blood lactic acid (Lac)] were collected.Results There was no significant difference in gender, age and cardiac arrest (CA) causes between the two groups. Compared with the bare-handed CPR group, the ROSC rate in the Thumper CPR group was significantly increased [68.57％ (48/70) vs. 51.25％ (41/80),χ2 = 4.642,P = 0.031], but there was no significant difference in return of spontaneous breathing rate [48.57％ (34/70) vs. 47.50％ (38/80),χ2 = 0.017,P = 0.896]. There was no significant difference in blood gas index between the two groups after 5 minutes of recovery. The PaO2 and SaO2 in the Thumper CPR group were significantly higher than those in the bare-handed CPR group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 88.13±5.06 vs. 84.26±5.53, SaO2: 0.828±0.068 vs. 0.766±0.031, bothP < 0.05), PaCO2 and Lac were significantly lower than those in the bare-handed CPR group [PaCO2 (mmHg):34.04±4.62 vs. 40.43±5.29, Lac (mmol/L): 6.90±2.07 vs. 8.50±2.12, bothP < 0.05].Conclusions In the process of emergency rescue, Thumper cardiopulmonary resuscitator is more successful than bare-handed CPR. The recovery rate of Thumper cardiopulmonary resuscitator is more conducive to save manpower and obtain better metabolic effect, which is worthy of clinical promotion and application.

Objective To analyze the features of onset, clinical pathological characteristics about the primary bladder mucinous adenocarcinoma.Methods From January 1990 to June 2015, we retrospectively reviewed the data from 15 patients diagnosed as primary bladder mucinous adenocarcinoma, including 10 male patients and 5 female patients.Their mean age was 58 years old, ranged from 41 to 78 years old.Among the fifteen patients, the initial symptoms included hematuria in 13 cases, lower abdominal pain in 1 case and urinary irritation symptom in 1 case.The ultrasound and CT scan revealed bladder tumors, which the size ranged from 2 to 6 cm.The location of bladder tumors included front wall in 12 cases, trigone zone in 2 cases and top wall in 1 case.Nine cases was suspected as tumor from urachal remnants.Eleven patients underwent partial cystectomy, three patients accepted the radical cystectomy and one case accepted transurethral resection of bladder tumor (TURBT).Result Pathological diagnosis was bladder mucinous adenocarcinoma in all patients, including nine from urachal remnant and the others from urothelimn.The tumor exhibited the mushroom liked prominence, which was associated with surface ulceration and infiltrated into the depth of bladder.Meanwhile, it was covered with thick mucinous substances.The histologic examination revealed the presence of andenoid structure, composed by various degree of diferenfiated mucinous cells.In cases with adenocarcinomas from urachus, the residue of urachal tissue could be noticed.The bladder mucous was intact or ulcerated.No sign of metaplasia was observed.In the pathological diagnosis, the classification included grade Ⅲ in 3 cases, grade Ⅱ in 7 cases and grade Ⅰ in 5 cases.Ten persons reported the information of the follow up.Eight of them, whose tumor originated from urachus, accepted bladder-sparing surgery.One died from acute myocardial infarction after 23 months postoperatively.And one died from cerebral hemorrhage 45 months postoperatively.The others have been followed up from 8 to 65 months with no sign of recurrence.In two cases with urothelial carcinoma, one was found the new urothelial carcinoma 50 months after TURBT and one died from cancer metastasis 29 months after partial cystectomy.Conclusions Primary mucinous adenocarcinoma of the bladder possess the relatively high malignant tendency.The hematuria is the main initial symptoms.The histologic examination revealed the presence of different differentiated mucinous cells and formed the andenoid structure.The case with urachal remnant adenocarcinoma has the better prognosis than other types.

Objective To investigate the cut-off point value of 1-hour plasma glucose of oral glucose tolerance test in the diagnosis of the T2DM and IGR.Methods Three hundred and fifty-four subjects (6.0mmol/L≤ FPG ＜ 7.0mmol/L) were participated in the OGTT.To get the cut-off point value of 1-hour plasma glucose in the diagnosis of the T2DM and IGR by applying the receiver operator characteristic curve,and compare it with the WHO diagnostic criteria.Results (1)The cut-off point value of screening T2DM by ROC curve was 12.90mmol / L,whose specificity was 77.1％ and sensitivity was 90％.Meanwhile the cut-off point value of screening IGR was 10.83mmol / L,whose specificity was 73.2％,and the sensitivity was 73.5％.(2)Among the 136 patients with type 2 diabetes mellitus that diagnosed by WHO criteria,115 patients could be diagnosed by 1hPG that more than FPG which could diagnose 81 patients.And the difference was statistically significant (P ＜ 0.05).Meanwhile,It was more than 106 patients that diagnosed by 2hPG,but there was no statistically significant.According to the diagnostic criteria of 2hPG ≥11.1mmol/L,there were 106 cases of T2DM.Among these patients,95 cases and 51 cases could be diagnosed respectively by 1 hPG and FPG,and there was statistically significant (P ＜ 0.01).(3)Application of the cut-off point of 1 hPG,NGT,IFG,CGI and DM re-grouped.FPG,2hPG increased gradually in order to NGT,IGR,DM.(4) No matter the blood glucose levels,1hPG and 2hPG had good correlation,(P =0.000).A significant correlation could be found between FPG and 2hPG only in hyperglycemia.The correlations between 1 hPG and FPG disappeared only in a normal level of blood glucose.Conclusion The cutoff point value of 1hPG is 12.90mmol/L which has advantage to diagnosis of type 2 diabetes mellitus.It is a useful complement to the WHO Diagnostic criteria.

Objective To evaluate the value of neck blood vessel colored doppler ultrasound (NBVCDU) and magnetic resonance angiography (MRA) to extracranial carotid artery stenosis in patients with transient ischemic attack (TIA).Methods After implementing NBVCDU and MRA examinations at the same time,45 TIA patients with at least one examination showing arteriostenosis in extracranial section were chosen to carry out cerebral digital subtraction angiography( DSA ),then the stenosis rate was calculated by American symptomatic carotid endarterectomy trial (NASCET) method.Results Regarding DSA as the gold standard,for 45 TIA patients that having 180 arteriostenosis in extracranial section, sensitivity,specificity,accuracy of NBVCDU examination was 93.51% ,95.15% ,94.44%, Kappa = 0.735; sensitivity,specificity,accuracy of MRA was 92.21% ,94.17% ,93.33% , Kappa =0.681; sensitivity,specificity,accuracy of NBVCDU combined with MPA was 97.40% ,99.03% ,98.33%, Kappa = 0.872.Conclusions The sensitivity and accuracy of arteriostenosis in extracranial section by NBVCDU examination is higher than that by MRA, and it is suitable in the crowd primary examination.NBVCDU combined with MRA has shown good consistence with DSA for diagnosing arteriostenosis in extracranial section,but can't replace DSA comlpetely.

Objective To determine the efficacy of liver cancer resection combined with splenectomy for patients with hepatocellular carcinoma with hypersplenism.Methods Among 35 patients with hepatocellular cancer and hypersplenism treated from March 2004 to January 2006 at our hospital,12 patients accepted simultaneous liver cancer resection and splenectomy (the splenectomy group)and 23 only accepted liver cancer resection (the non-splenectomy group).The liver function,platelets and white blood cells were analyzed retrospectively.Results All the operations were successfully carried out.Within 1 week after operation,the white blood cell count increased from (3.2 ± 1.7) × 109/L to (8.5±-5.3) × 109/L,the platelet count increased from (52.6±23.7) × 109/L to (245.3±94.6) ×109/L(P＜0.01) in the group of patients with combined splenectomy,while little change occurred in the non-splenectomy group.The liver function in the splenectomy group recovered to the preoperational value within 1 week.Two years after operation,7 (58.3％) patients were still surviving in the splenectomy group and the mean tumor-free survival was (16.4 ± 4.3) months compared with (14.3 ±5.2) months in 10 (43.5％) patients in the non-splenectomy group,(P＜0.005).Conclusion Liver cancer resection combined with splenectomy was efficacious to hepatocellular cancer with hypersplenism.

Objective To investigate β-lactamase gene and class 1 integron gene from 60 clinical Acinetobacter baumannii isolates.Methods The minimal inhibitory concentrations (MICs) for 16 antibiotics widely used were determined using the standard broth microdilution method.The β-lactamase gene,class 1 integron gene and adeB gene were determined by PCR and then sequenced.Results Fifty-three strains of the 60 A.baumanii isolates were multi-drug resistant.OXA-23 gene was detected positive in six A.baumanii isolates,which were all resistant to more than five antimicrobial agents including carbapenem and showed high resistance to many antibiotics.Thirtyeight strains earring PER-1 gene showed higher resistance to cephalosporins than those without this gene (P＜0.01).Class 1 integron gene was positive in 45 strains,which exhibited significantly higher multiple resistance than those without this gene (P＜0.01).Twenty-five strains carrying both class 1 integron and PER-1 genes had a markedly higher multiple resistance (P＜0.01),but not in resistant level,compared to the 7 strains without these two genes.Conclusion Class 1 integron and β-lactamase gene may be the causes of muhidrug-resistance of A.baumanii.The strains carrying OXA-23 gene always showed multiple and high resistance to several antibiotics,so effective measures must be taken to control the epidemic of these strains.