Objective To explore the value of systemic immune-inflammation index(SⅡ)in differentiating acute and chronic cholecystitis.Methods A total of 297 patients with cholecystitis who underwent cholecystectomy in Jinshan Hospital,Fudan University from August 2020 to November 2023 were selected,and were divided into acute cholecystitis group(n=192)and chronic cholecystitis group(n=105).The patients in acute cholecystitis group were further divided into severe subgroup(n=114)and mild subgroup(n=78).The differential diagnosis values of SⅡ and neutrophil-to-lymphocyte ratio(NLR)in acute and chronic cholecystitis were evaluated by ROC curve.Results Compared with chronic cholecystitis group,males were more,older,the incidence of hypertension was higher,drainage volume increased,drainage time,hospital time,and surgical duration were all longer,blood cells,neutrophil count,monocyte count increased,total bilirubin,direct bilirubin,and creatinine were higher,SⅡ and NLR increased in the acute cholecystitis group(P＜0.05).Compared with the severe subgroup,the drainage volume decreased,drainage time,hospital stay,and surgical duration were shorter,white blood cell count,neutrophil count,monocyte count,and total bilirubin decreased,while lymphocyte count increased,SⅡ and NLR decreased in the mild subgroup(P＜0.05).The optimal cutoff values of SⅡ and NLR for distinguishing acute cholecystitis from chronic cholecystitis were 797.96 and 3.65,and the AUC were 0.847 and 0.869,with 73.2％and 74.2％of sensitivity,and 86.7％and 89.5％of specificity.The optimal cutoff values of SⅡ and NLR for distinguishing acute severe cholecystitis from mild cholecystitis were 1 056.59 and 4.65,the AUC were 0.768 and 0.779,with 77.0％and 82.3％of sensitivity,and 67.5％and 62.3％of specificity.There was no statistically significant difference between the values of SⅡ and NLR for distinguishing acute severe and acute cholecystitis.Conclusion SⅡ is a good hematological indicator for distinguishing acute cholecystitis from chronic cholecystitis with similar value to NLR.

Objective To investigate the effect of different modes of administration of dexmedeto-midine pre-nasal spray combined with pumping and conventional pumping on remifentanil and heart rate var-iability(HRV)in patients undergoing oral and maxillofacial surgery.Methods Ninety patients undergoing elective oral and maxillofacial surgery,43 males and 47 females,aged 18-64 years,BMI 18-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected.The patients were divided into three groups by random number table method:pre-nasal spray combined with pump injection group(group PP),conventional pump injection group(group CP),and control group(group C),30 cases in each group.Patients in group PP were given a nasal spray of dexmedetomidine at a dose of 0.5 μg/kg,group CP and group C were given the same amount of normal saline by the same method 45 minutes before entering the room on the day of surgery.Dexmedetomidine was injected intravenously in group PP at doses of 0.5 μg/kg and in group CP at dose of 1 μg/kg for 10 minutes,and group C was given the same amount of normal saline 10 minutes before induc-tion of anesthesia.Ramsay sedation score on admission,duration of surgery,the dose of remifentanil during induction and maintenance of anesthesia,room admission(T1),induction intubation(T2),10 minutes after skin incision(T3),and extubation(T4),RMSSD,SDNN,LF,HF,TP,LF/HF ratio and other HRV analysis indicators,HR,MAP,and BIS values were recorded.The incidence of PONV and the use of analgesics within 24 hours after operation were recorded.Results Compared with group C,the MAP was significantly reduced,RMSSD,SDNN,and logTP were significantly increased,and LF/HF was significantly decreased in group PP at T,(P＜0.05),the LF/HF were significantly reduced in groups PP and CP at T2-T4(P＜0.05),the dosage of remifentanil during the anesthesia induction,the incidence of PONV,and the use rate of analgesic drugs in 24 hours were significantly reduced in groups PP and CP(P＜0.05).Compared with group CP,the RMSSD,SDNN,logLF,logHF,and logTP were increased sig-nificantly in group PP at T,(P＜0.05),the logHF were increased significantly in group PP at T2 and T4(P＜0.05),the Ramsay sedative evaluation was increased significantly,the dosage of remifentanil was sig-nificantly reduced during the maintenance of anesthesia in group PP(P＜0.05).Conclusion After the use of dexmedetomidine,the indicators related to stress level in HRV analysis were significantly reduced,and the dosage of opioids was significantly reduced.The use of dexmedetomidine pre-nasal spray combined with pump injection can further reduce the dosage of opioids during the anesthesia maintenance phase.

Objective To investigate the syndrome differentiation characteristics of children with atopic dermatitis(AD)and the immune imbalance status in children with different syndrome types of AD.Methods A total of 159 AD children and 100 normal control children were enrolled.The peripheral blood eosinophil(Eo)count was measured by impedance method,total serum immunoglobulin E(IgE)by immunoturbidimetric assay,and interferon-gamma(IFN-γ),interleukin-4(IL-4),interleukin-5(IL-5)and interleukin-17(IL-17)were measured by multiple microspheres flow immunofluorescence assay.Results Among 159 AD children,syndrome of heart-fire and spleen-deficiency was most commom,accounting for 38.4%,followed by syndrome of blood-deficiency and wind-dryness(22.0%),syndrome of heat accumulation in heart and spleen(20.1%)and syndrome of spleen-deficiency and dampness-accumulation(19.5%).Compared with normal control group,there was no significant difference in serum IFN-γ level among different syndrome types of AD.The levels of peripheral blood Eo,serum total IgE,IL-4 and IL-17 in AD with heart-fire and spleen-deficiency syndrome were significantly increased(P<0.05).The levels of peripheral blood Eo,IL-4,IL-5 and IL-17 in AD with blood-deficiency and wind-dryness syndrome were significantly increased(P<0.05).The levels of IL-4,IL-5 and IL-17 in AD with heat accumulation in heart and spleen syndrome were significantly increased(P<0.05).The levels of peripheral blood Eo and serum IL-4 in AD with spleen-deficiency and dampness-accumulation syndrome were significantly increased(P<0.05).Conclusion Heart-fire and spleen-deficiency syndrome is the most common type in children with AD,however,the main type under 3 years old is heat accumulation in heart and spleen syndrome.Th2/Th17 immune imbalance are the main pathogenesis in heart-fire and spleen-deficiency syndrome,blood-deficiency and wind-dryness syndrome and heat accumulation in heart and spleen syndrome,and Th2 immune imbalance is the main pathogenesis of spleen-deficiency and dampness-accumulation syndrome.

Objective:To evaluate the efficacy and safety of sodium hyaluronate gel in preventing adhesion after prophylactic enterostomy.Methods:One hundred and twenty four patients from 6 hospitals were enrolled in this prospective multi-center randomized controlled trial. Patients were randomized into the study group ( n=59) or the control group ( n=65).All patients underwent prophylactic enterostomy. Patients of study group received odium hyaluronate gel for adhesion-prevention,while those in control group did not receive any adhesion-prevention treatment. The incidence of moderate to severe adhesion around the incision in the stoma area were evalutated during stoma reduction surgery. Results:The incidence of moderate to severe adhesion around the incision in the stoma area was 6.3% in the study group, the difference was statistically significant ( P<0.05) compared to that of the control group (32.6%). Conclusion:Sodium hyaluronate gel can safely and effectively reduce the incidence of moderate and severe adhesions after abdominal surgery.

Objective:To investigate the differences between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and insulin resistance (IR) and the relationship between Lp-PLA2 and IR and homocysteine (Hcy) levels in patients with type H and non-type H hypertension.Methods:A total of 298 patients with essential hypertension (observation group) who visited Lu′an Hospital of Traditional Chinese Medicine in Anhui Province from January 2018 to January 2020 were selected, and 564 healthy subjects were as control group. According to age, gender and body mass index (BMI), propensity score matching was conducted, and the matching relationship was determined according to 1∶1 nearest neighbor matching method. Finally, 166 cases were included in the observation group and the control group. Type H hypertension was defined as essential hypertension with an Hcy level of > 10 mol/L.Results:The smoking proportion, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), fasting insulin (FINS), fibrinogen (FIB), hypersensitive C reactive protein (hs-CRP), LP-PLA2, Hcy, and homeostasis model of assessment for insulin resistance index (HOMA-IR) in the observation group were higher than those in control group: 24.7% vs. 13.9%, (5.06 ± 1.65) mmol/L vs. (4.60 ± 1.42) mmol/L, (2.92 ± 0.97) mmol/L vs. (2.62 ± 0.86) mmol/L, (5.80 ± 1.03) mmol/L vs. (5.12 ± 0.94) mmol/L, (13.06 ± 5.14) U/L vs. (9.25 ± 4.67) U/L, (3.28 ± 1.16) g/L vs. (2.17 ± 1.01) g/L, (2.00 ± 1.09) mg/L vs. (0.52 ± 0.43) mg/L, (161.98 ± 86.84) mg/L vs. (126.87 ± 56.84) mg/L, (15.00 ± 5.06) mol/L vs. (11.54 ± 3.63) mol/L and 3.49 ± 1.25 vs. 2.03 ± 1.11 ( P < 0.05), and the high density lipoprotein cholesterol (HDL-C) was lower than that in control group: (1.15 ± 0.56) mmol/L vs. (1.33 ± 0.66) mmol/L ( P < 0.05). The age, BMI, smoking ratio, TC, FPG, FINS, FIB, hs-CRP and Hcy in H-type hypertension group were higher than those in non-H-type hypertension group: (56.41 ± 11.07) years old vs. (49.61 ± 10.58) years old, (27.92 ± 4.02) kg/m 2 vs. (24.23 ± 4.11) kg/m 2, 31.1% vs. 14.3, (5.32 ± 1.54) mmol/L vs. (4.63 ± 1.24) mmol/L, (5.97 ± 1.03) mmol/L vs. (5.51 ± 0.98) mmol/L, (14.29 ± 5.04) U/L vs. (11.06 ± 4.57) U/L, (3.48 ± 1.10) g/L vs. (2.95 ± 0.83) g/L, (2.48 ± 1.21) mg/L vs. (1.22 ± 1.02) mg/L, 16.13 (12.96, 23.20) mol/L vs. 7.63 (6.58, 8.35) mol/L ( P < 0.05), and the HDL-C was lower than that in non-H-type hypertension group: (1.05 ± 0.54) mmol/L vs. (1.31 ± 0.78) mmol/L ( P < 0.05). HOMA-IR was 2.27 (1.60, 3.34) and Lp-PLA2 was 61.64 (53.25, 75.47) in patients with non-H-type hypertension. HOMA-IR was 3.34 (2.63, 443) and Lp-PLA2 was 212.25 (120.35, 278.62) in patients with type H-type hypertension. Lp-PLA2 and Lp-PLA2 were higher in patients with H-type hypertension than those in patients with non-H-type hypertension ( P < 0.05). In patients with essential hypertension, there was a strong positive correlation between Hcy and HOMA-IR and Lp-PLA2 ( r = 0.655 and 0.774, P < 0.05). Age, BMI, TC, FPG, FINS, FIB, hs-CRP, HOMA-IR and LP-PLA2 were independent risk factors for Hcy increase ( P < 0.05), while HDL-C was a protective factor for Hcy increase ( P < 0.05). Conclusions:Patients with type H-hypertension have a higher HOMA-IR and an increased level of Lp-PLA2, which is correlated with an increase in Hcy.

Objective:To evaluate the efficacy of radiofrequency thermocoagulation with CT-guided transforaminal puncture of intervertebral foramen through the superior margin of costotransverse joint for refractory post-herpetic neuralgia (PHN) in the upper thoracic segment.Methods:Thirty patients with PHN in the upper thoracic segment underwent radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture. The visual analogue scale and self-rating depression scale were used to evaluate the degree of postoperative pain and mental state before and after treatment, and patients were followed by telephone or outpatient visit.Results:No infection occurred after radiofrequency thermocoagulation in all 31 PHN patients. After operation, all patients had hypoesthesia in skin of the original pain area, the pain was significantly relieved, and the mental state improved significantly. The VAS scores were 5.94±0.93, 2.74±0.69, 2.68±0.70 and 2.45±0.51 before and 3 hours, 1 week, 1 month after treatment( t=18.80, t=18.80, t=16.44, all P<0.01). The SDS scores were 58.6±12.2, 47.7±4.4, 48.1±4.8 before and 1 week, 1 month after treatment( t=6.75, t=5.86, all P<0.01). There were 13 patients with moderate or severe depression before treatment, while no patients with moderate or severe depression after treatment; only 5 patients had mild depression one month after surgery. There was no hypoxemia under nasal catheter during the operation. Intraoperative hypertension was found in 19 cases; after treatment with Urapidil (12.5 - 50.0 mg), the blood pressure was not higher by 20% of the basal blood pressure and<180/100 mmHg (1 mmHg=0.133 kPa). No pneumothorax, perioperative cardiovascular and cerebrovascular accidents occurred. Conclusion:Radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture through the superior margin of costotransverse joint can effectively relieve refractory PHN of the upper thoracic segment with safety.

Objective ToexploretheMRIfeaturesanddifferentialdiagnosisofgemistocyticastrocytoma(GemA).Methods The MRIfeaturesof10casesofGemAprovedbysurgeryandpathologywereinvestigatedretrospectively(thelocationoftumor,tumor shape,boundary,signalandenhancement)andtheliteraturewasreviewed.Results All10casesofGemA weresupratentorialand solitary.Ofthese10cases,7caseswerelocatedinthefrontallobe,5casesinthetemporallobe,6casesinmultiplelobesandinvaded theoppositebraintissuesthroughcorpuscallosum.8casesweresolidGcystic,8casespresentedwithunclearboundary,only2cases hadclearboundary.Therewasnoedemaormildedemain7casesandobviousedemain3cases.Thesolidpartoftumorswereisointense orslighthypointenseonT1WI,only1caseshowedhighintensityonT1WI,isointenseorslighthyperintenseonT2WI.CTsuggested calcificationin2cases.6casesweremildlyenhanced,4casesweremarkedlyenhanced.MRSshowed(n＝4)thatCHopeakwasmildly ormoderatelyincreased,NAApeakwassignificantlyreduced,theaverageratioofCho/NAA was2.91.DWIshowedhyperintenseor slighthyperintense(n＝3),theADCaveragevalueoftumorROIwasabout(1.150±0.081)×10－3 mm2/s.1caseofSWIsequence showedthickeningandcircuitousvascularshadow.Conclusion AsMRIofGemAischaracterizedbyhighandlowgradegliomas,the preoperativediagnosisisdifficult.Combiningenhancementwithfunctionalexamination,itisexpectedtoimprovetheaccuracyofpreoperative diagnosisofGemA.

Enhancement of health management capability and resource utilization efficiency of hospitals has become an imperative need to deepen the healthcare reform. The high-value consumables are subject to point-to-point accurate tracking based on code scan, relying on the hospital′s WeChat official account for WeChat-based management. The WeChat platform enables the system to automatically push the preset procurement plan to the mobile terminal of the managers via the low-inventory alarm at the departments. On the other hand, vendors can use their own mobile terminals to receive in time the plans, query product inventory, and last month invoicing information. These measures facilitate the hospital management on high-value consumables.

Objective: To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients. Methods: From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author′s affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author′s affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction. Results: (1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ²=13.676, P<0.05 or P<0.01). Conclusions In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.

Objective To explore the value of 3D-ASL parameters for predicting glioma grade before operation and the relationship between the expression of Ki-67 and microvessel density(MVD).Methods 3DASL images of 50 patients with pathologically proven gliomas (high grade:n=20,1ow grade:n 30) were analyzed retrospectively.The mean maximum relative cerebral blood flow was obtained by the hot spot method.The Ki-67 labeling index and MVD of surgical specimen were measured.The results were analyzed statistically.Results The mean rCBF,Ki-67 and MVD of low grade gliomas (n=30) were 1.69±1.27,3.73％±3.01％,25.43±13.03,while the high grade gliomas (n=20) were 3.18± 1.46,49.25％ ±20.15％,58.69±20.39 respectively.The difference between the two groups was statistically significant (P＜0.01),which was positively correlated with the grade(r=0.620,0.871,0.698,P＜0.01).rCBF was positively correlated with Ki-67 and MVD (r =0.535,0.723,P ＜0.01).Ki 67 labeling index was positively correlated with MVD (r=0.629,P＜0.01).Conclusion The rCBF value is useful for predicting glioma grade before operation and related to tumor MVD and cell proliferation.The biologic behavior of glioma can be predicted to a certain extent.