Objective To explore the clinical characteristics and prognostic factors of elderly patients with bacterial pneumonia and sepsis.Methods A retrospective cohort study was conducted to collect the basic characteristics and clinical features of the elderly(age ≥80 years old)disabled patients with bacterial pneu-monia and sepsis.The survival status of the patients was observed 30 days after admission,and the differences of clinical characteristics of the patients in different states were compared.COX regression model was used to analyze the influencing factors of patients'prognosis.Results A total of 63 patients were included,with an average age of(86.84±4.83)years,including 49 cases in the survival group and 14 cases in the death group.Compared with the survival group,the death group had higher sequential organ failure assessment(SOFA)score,△ SOFA score,and acute physiological and chronic health evaluation(APACHE Ⅱ)score at admission,lower oxygenation index,serum albumin,and endogenous creatinine clearance before and after treatment,higher D-dimer levels before and after treatment,and higher proportions of intravenous crystalloid fluid sup-plementation,combined use of 20％human serum albumin injection,and use of vasoactive drugs during fluid resuscitation,with statistically significant differences(P＜0.05).COX regression analysis showed that A-PACHE Ⅱ score at admission(HR=1.268,95％CI:1.093-1.471,P=0.002),urea/creatinine within 24 hours after treatment(HR=1.070,95％CI:1.015-1.128,P=0.011),the combination of 20％human albu-min injection during fluid resuscitation(HR=0.077,95％CI:0.010-0.624,P=0.016)were influential fac-tors in the survival of patients at 30 days.Conclusion APACHE Ⅱ score at admission and urea/creatinine within 24 hours after treatment are valuable for predicting high risk of death in elderly and disabled patients with bacterial pneumonia and sepsis.Combined treatment with 20％human blood albumin injection can im-prove prognosis.

Objective To explore the effects of wogonin on cognitive function and neuroinflamma-tion in VaD rats by regulating AMPK/SIRT1 pathway.Methods 90 VaD rats were randomly di-vided into model group,low-,medium-and high-dose wogonin groups(50,100,200 mg/kg),and high dose+AMPK inhibitor(20 mg/kg)group,18 animals per group.Another 18 normal rats served as sham operation group.ELISA was utilized to measure the contents of IL-1β,TNF-α and IL-6 in hippocampal tissues.Western blotting was conducted to detect the expression of Iba-1,p-AMPK,AMPK and SIRT1 in hippocampal tissues.Results Compared with the sham operation group,the model group had longer escape latency,and elevated contents of IL-1β,TNF-α and IL-6,number of Iba-1 positive cells and expression level of Iba-1 protein in hippocampal tissue,shorter stay time at original platform,and lower expression of p-AMPK/AMPK and SIRT1 in hippocampal tissues(P＜0.05).Treatment of three doses of wogonin,in a dose-dependent man-ner,reduced escape latency,and decreased levels of IL-1β,TNF-α and IL-6,number of Iba-1 posi-tive cells and expression of Iba-1 protein in hippocampal tissue,but longer stay time at original platform,and enhanced expression of p-AMPK/AMPK and SIRT1 protein in hippocampal tissue when compared with the model group(P＜0.05).The high dose+AMPK inhibitor group showed longer escape latency(47.64±5.39 s vs 26.45±3.27 s),shorter stay time at original platform(21.78±3.51 s vs 35.22±5.02 s),increased levels of IL-1β,TNF-α and IL-6,number of Iba-1 positive cells and expression of Iba-1 protein in hippocampal tissue,and lower expression levels of p-AMPK/AMPK and SIRT1 in hippocampal tissue when compared with the high-dose group(P＜0.05).Conclusion Wogonin may improve cognitive function and hippocampal tissue patho-logical damage in VaD rats by activating the AMPK/SIRT1 pathway,and inhibit neuroinflammation.

Objective To investigate the impact of usnic acid on neuronal necroptosis in rats with cerebral infarction by regulating the receptor-interacting protein kinase 1(RIPK1)/receptor-interacting protein kinase 3(RIPK3)/mixed lineage kinase domain-like protein(MLKL)signaling pathway.Methods The rat model of cerebral infarction was established by middle cerebral artery occlusion and reperfusion(MCAO/R).The successfully modeled rats were divided into model group,NEC-1(RIP1 inhibitor)group,low-,medium-,and high-dose of usnic acid groups,with 20 rats in each group.Another 20 rats were selected as a sham-operation group.After 3 days of drug intervention,the modified Neurological Severity Scale(mNSS)was applied to evaluate the degree of neurological damage of rats in each group.TTC staining was applied to detect the volume of cerebral infarction.HE staining was selected to observe pathological damage in brain tissue.PI/NeuN staining was selected to observe neuronal necrosis.RT-qPCR was used to detect mRNA levels of RIPK1,RIPK3 and MLKL in rat ischemic brain tissue.Western Blot was used to determine the expressions of RIPK1/RIPK3/MLKL signaling pathway related proteins in rat ischemic brain tissue.Results Compared with the sham-operation group,the neural cells in the model group showed structural damage,cell disrupted,deformation,and nuclear pyknosis,furthermore,the mNSS score,the cerebral infarction volume,proportion of PI-positive neurons were significantly increased(P＜0.05).The mRNA levels of RIPK1,RIPK3,MLKL in brain tissue,ratio of p-RIPK1/RIPK1,and the levels of RIPK3 and MLKL proteins were obviously increased(P＜0.05).Compared with the model group,the damage degree of neurocyte morphology in the low-,medium-,and high-dose of usnic acid groups was gradually alleviated,the nuclear membrane was gradually became clear,and the cell body was gradually returned to normal.The neurocyte morphology in the NEC-1 group was basically intact,and the nuclear membrane was basically clear.The mNSS score,cerebral infarction volume and proportion of PI-positive neurons in NEC-1 group and usnic acid groups were significantly decreased(P＜0.05).The mRNA levels of RIPK1,RIPK3,MLKL,ratio of p-RIPK1/RIPK1,and levels of RIPK3 and MLKL proteins in brain tissue were obviously reduced in usnic acid groups and NEC-1 group.Also,there was dose-dependent decrease in usnic acid groups(P＜0.05).No statistically obvious difference was found between the high-dose usnic acid group and the NEC-1 group(P＞0.05).Conclusion Usnic acid inhibits neuronal necroptosis in rats with cerebral infarction by inhibiting the RIPK1/RIPK3/MLKL signaling pathway,thereby alleviating brain injury in rats with cerebral infarction.

This paper rounded up the resources and advantages leveraged by the hospital′s burn and plastic surgery department as a national key discipline. The department practiced medical services for chronic wounds in the regional hierarchical medical system for chronic wounds to promote the development medical alliances. IT development of the hierarchical medical network has achieved disease information sharing, namely centralized patients screening, patients referral confirmation, mutual recognition of test results, online consultation and treatment follow-up. Other achievements include standardization of medical criteria for chronic wounds by means of effective integration of resources imbalance within the network and improvement of internal medical regulations; elevation of primary level innovation capacity and services by means of high-caliber specialists working at primary institutions and mutual exchanges in between; effective medical cost control via guarantee system building, thus enhancing the public benefit nature of public hospitals. The paper also probed into problems and solutions expected in the way of promoting the chronic wound hierarchical medical system.

Objective: To investigate the relationship between radiofrequency ablation immediately after enhanced CT scanning and the occurrence of contrast agent spillover and postoperative severe bleeding, and analyze the risk factors for hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 199 patients with hepatocellular carcinoma who underwent radiofrequency ablation of liver cancer in our hospital from January 2016 to January 2017 was reviewed. A total of 232 cases were treated with ablation. The agent spillovers were divided into two groups, one for the contrast agent spill group and the other for the non-contrast agent spill group. Its basic clinical data, laboratory data related to the risk of bleeding, and imaging data were analyzed to explore their clinical treatment effects and the risk factors for their occurrence. According to different data, t-test, χ2 test or logistic regression test was used for statistical analysis. Results: In 199 patients, a total of 232 cases were treated with ablation, including 138 males and 61 females. The average age was (57.56 ± 12.09) years and the average diameter of lesions was (3.42 ± 2.30) cm. A total of 30 cases (12.93%) of contrast agent spillover occurred immediately after the ablation of CT scanning needle. There were no severe bleeding and no special clinical intervention after the operation. The other 202 cases were non- contrast agent spill group, but 2 cases had severe bleeding and had corresponding clinical interventions. Univariate analysis showed that there were statistically significant differences in thoracentesis (P = 0.019), complications of cirrhosis (P < 0.001), and histological types of liver cancer (P = 0.013), and other clinical data [age, lesion size]. There were no significant differences in Child-Pugh classification, preoperative hemoglobin (HGB), platelet count, prothrombin time, APTT, international standardized ratio, number of puncture needles, and puncture length. There was also no significant difference in postoperative HGB (P = 0.160), preoperative-postoperative HGB change (P = 0.999), and length of hospital stay (P = 0.730) between the two groups. Logistic regression analysis showed that with cirrhosis (OR = 5.59, P < 0.001), transthoracic puncture (OR = 2.67, P = 0.021) may be a risk factor for contrast agent spillover after CT-enhanced CT scan in patients with hepatocellular carcinoma. Conclusion Contrast agent spillover is not uncommon in the evaluation of curative effect of CT immediately after ablation (12.93%). It is not predictive for the occurrence of postoperative severe bleeding and does not require excessive clinical intervention. Liver cirrhosis and transthoracic cavity puncture may be the risk factors for its occurrence. The risk of severe postoperative bleeding should not be ignored for patients who have no contrast agent spills after surgery.

Objective To explore the impact of antiplatelet agents on the occurrence of hemorrhage after percutaneous nephrostomy (PCN).Methods Totally 197 patients (244 kidneys) underwent PCN were enrolled and divided into postoperative hemorrhage group and without postoperative hemorrhage group.The possible factors of the postoperative hemorrhage were analyzed.Results Post-operative hemorrhage occurred in 23 patients with 27 kidneys (27/244,11.07％).Univariate analysis showed that except for antiplatelet drugs,the other factors had no statistical difference between the two groups (P＞0.05).Logistic regression analysis showed that taking dual-antiplatelet was the risk factor of hemorrhage after PCN (OR=12.381,P =0.002).Conclusion Single aspirin therapy can not increase the risk of hemorrhage after PCN,while taking dual-antiplatelet might increase the risk of hemorrhage.Normal clotting function is also a guarantee of preventing hemorrhage after PCN.

Objective To explore the early laboratory indicators for risk of intravenous immunoglobin-resistant Kawasaki diseases. Methods The clinical data were retrospectively analyzed in 881 Kawasaki disease patients (group A: 26 cases of intravenous immunoglobin-resistant; group B: 855 cases of intravenous immunoglobin-sensitive) from July 1, 2015 to June 30, 2016. After 1:3 matching with age and sex, the regression model for each of variables including sex, age, fever days, temperature, red blood cell count (RBC), white blood cell count (WBC), neutrophil (N), lymphocyte (L), platelet count (PLT) and C reactive protein (CRP), was constructed by conditional logistic regression analysis. Results Compared with group B, group A had significantly lower RBC count and higher PLT (P<0.05). Logistic regression analysis showed that, with the age, the regression model was Y=-2.87+0.01×PLT (PLT OR=1.01, 95％ CI: 1.00～1.01, P<0.01); with the sex, Y=-32.98+0.44×WBC+0.28× N+0.01×PLT (WBC OR=1.55, 95％ CI: 1.17～2.05, P<0.01; N％ OR=1.32, 95％ CI: 1.04～1.68, P<0.05; PLT OR=1.01, 95％ CI 1.00～1.01, P<0.01). Conclusion In case that abnormally high levels of PLT exist in confirmed Kawasaki disease, it should be aware of possibility of the intravenous immunoglobin-resistant Kawasaki disease.

Objective To evaluate the safety and clinical efficacy of the treatment for symptomatic uterine fibroids with MR guided focused ultrasound surgery(MRgFUS)in China. Methods Twenty five selected patients with symptomatic uterine fibroids underwent MRgFUS treatment in our perspective clinical study. Immediately after treatment the patients accepted pelvic enhanced MRI scans, and recorded the non-perfused volume(NPV)and calculated the non-perfused volume ratio(NPV%). We recorded the symptom severity score(SSS) and standard SSS change(ΔSSS)of the patients before, during and 1 week after treatment together with 1, 3, 6, 12 months and several years follow-up. The patients accepted pelvic enhanced MRI scans in the follow-up of 12 months after treatment,and recorded the volume and the volume change(ΔV) of fibroids. We observed the adverse reactions during the treatment and the follow-ups. Wilcoxon test or t test and Pearson or Spearman correlation analysis were used to analyze the data. Results Totally 31 fibroids of 25 patients were completed the treatment. Twenty two patients completed the 12 months follow-up and 15 patients completed the long-term follow-up which was during 34 to 66 months, median follow-up duration was(55 ± 11)months. The NPV was 4.5 to 295.0 cm3, median was 37.0 cm3. The NPV%was 6%to 94%, average was(64 ± 23)%. According to our follow up, the standard SSS continued to decline. Compared with screening standard SSS, all the follow-up standard SSS had significant difference(P<0.05), except for that of the first week. Among all the follow up, only the standard SSS change of 1 week after the treatment had a correlation with NPV%(r=0.552,P=0.005), and the others had no significant correlation with NPV%(P>0.05). The uterine fibroids volume decreased in the 12 months follow-up, which had a significant difference with the volume before treatment(P<0.05). And there was also correlation between the fibroids volume change and NPV(r=0.587,P=0.017). There was no correlation between the volume or volume change and standard SSS or standard SSS change(all P>0.05). None serious adverse effects occurred in all cases. Conclusion MRgFUS is a safe and effective way to treat uterine fibroids.

Objective To investigate the feasibility of using CT texture analysis to differentiate among lipid-poor adrenal adenoma,pheochromocytoma and adrenal metastases.Methods 66 lipid-poor adrenal adenoma,98 pheochromocytoma and 101 adrenal metastases lesions were analyzed retrospectively.All the patients had abdominal non-enhanced CT and adrenal enhanced CT scans.We used TexRAD software to analyze the textural features of CT images and compared the differences in each texture parameter among three adrenal lesions.Results On non-enhanced CT images,there were significant differences in Mean and Kurtosis at all the texture scales(SSF 0-6) among the three types of adrenal lesions (P<0.05),as well as SD at fine and coarse texture scale (SSF 2,6)(P<0.05).Entropy (SSF 0-3, 5-6) and MPP (SSF 0-2, 4-6) were significantly lower in lipid-poor adrenal adenoma and adrenal metastases than that in pheochromocytoma (P<0.05).There were significant differences in Skewness (SSF 0-3) among three types of lesions, which was lowest in pheochromocytoma and highest in adrenal metastases.On enhanced CT images, Mean, SD, Entrophy and MPP showed significantly differences among the three types of adrenal lesions at all the texture scales (SSF 0-6) (P<0.05), which were all highest in pheochromocytoma and lowest in adrenal metastases.Skewness (SSF 0) and Kurtosis (SSF 0, 2) were significantly lower in adrenal metastases than that in lipid-poor adrenal adenoma and pheochromocytoma (P<0.05).Conclusion There are significant differences in CT texture analysis parameters among lipid-poor adrenal adenoma,pheochromocytoma and adrenal metastases.CT texture analysis has potential clinical application values in differentiating these three adrenal lesions.

Interventional therapy is an important treatment for biliary stenosis.The treatment methods are different ac cording to the different causes.Conventional interventional therapy include biliary drainage,balloon dilatation and stent implantation.There are some new treatment methods such as radiofrequency catheter ablation and biliary stent loaded with 125I seeds.The applications of interventional therapy in biliary stenosis were reviewed in this article.