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Objective:To understand the epidemiology, clinical characteristics and associated risk factors of severe adenovirus(ADV)pneumonia in children, providing the basis for targeted prevention and treatment.Methods:Clinical features of children with ADV pneumonia at Children′s Hospital of Soochow University from January 2011 to December 2020 were retrospectively analyzed.According to the severity of the disease, cases were divided into severe ADV pneumonia group and common ADV pneumonia group.The epidemiological and clinical characteristics of two groups were compared, and risk factors for the occurrence of severe ADV pneumonia were analyzed.Results:A total of 1 158 patients with ADV pneumonia were enrolled, including severe ADV pneumonia 104 cases(8.98%) and ordinary ADV pneumonia 1 054 cases(91.02%).The median age of severe ADV pneumonia group was 1.17 (0.83, 2.73) years, which was significantly younger than that of common ADV pneumonia group 3.16 (1.50, 4.50) years( P<0.05), and 77.89% (81/104) of them were younger than 3 years old.The occurrence of severe ADV pneumonia was predominant in winter and spring, accounting for 71.15% (74/104).Cough was present in 89.42% (93/104) and fever in 99.01% (103/104) of the severe ADV pneumonia group.Compared with the common ADV pneumonia group, the severe ADV pneumonia group had a significantly longer febrile time[10(6, 14)d vs. 5(4, 7)d, P<0.05], significantly higher incidence of shortness of breath, wheezing, convulsions/coma[100% vs. 2.09%, 45.19% vs. 13.57%, 10.57% vs. 1.99%, P<0.05], and significantly higher incidences of emphysema, pleural effusion, bronchial signs, pulmonary solids, and atelectasis [21.15% vs. 2.09%, 5.77% vs. 0.19%, 4.81% vs. 0, 3.85% vs. 0.09%, P<0.05].Multivariable Logistic regression showed that age younger than 1.71 years old, wheezing, and the presence of underlying diseases (moderate to severe anaemia, congenital heart disease, neurological disease) were risk factors for the development of severe ADV pneumonia ( P<0.05).Receiver operating characteristic curve analysis showed that the sensitivity and specificity of age<1.71 years old(20 months old) for predicting the occurrence of severe ADV pneumonia were 65.4% and 71.5%, respectively. Conclusion:The age of most severe ADV pneumonia is less 3 years in Suzhou.It usually occurres in winter and spring, with fever, cough, shortness of breath, and wheezing as the main symptoms.Pulmonary manifestations such as pleural effusion, emphysema, pulmonary consolidation, and atelectasis may occur.The underlying disease, wheezing, and age of onset less than 1.71 years (20 months) old are independent risk factors for severe ADV pneumonia.
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Objective:To compare the treatment outcomes between laparoscopic versus open radical resection for hilar cholangiocarcinoma (HCCA).Methods:From January 2017 to January 2020, the clinical data of 34 patients who underwent radical resection for HCCA were retrospectively collected and analyzed. These patients were divided into the laparotomy group ( n=17) and the laparoscopic group ( n=17) based on the operation they received. Clinical data including perioperative outcomes, oral re-intake time, first out-of-bed activity time, drainage tube removal time, postoperative hospital stay, 30-day and 90-day mortality rates were compared between groups. Results:Of 34 patients who underwent radical for HCCA in the study, there were 16 males and 18 females, aged (64.3±1.7) years. The mean operation time of the laparotomy group was significantly less than those in the laparoscopic group [(436.2±33.4) vs (522.1±24.0) min, P<0.05]. The 2 groups showed comparable results in extent of operation, intraoperative bleeding, incidences of portal vein reconstruction, yields of lymph nodes, and tumor diameter. The laparoscopic group showed advantage trends over the laparotomy group in incidences oral re-intake time [(4.7±0.3) vs (4.6±0.3) days], first out-of-bed activity time [(2.9±0.4) vs (2.2±0.3) days], drainage tube removal time [(12.7±1.3) vs (11.1±1.0) days] and postoperative hospital stay [(18.3±1.7) vs (15.8±1.3) days], but the differences failed to reach statistical significance ( P>0.05). Conclusion:Compared with open surgery, laparoscopic radical resection of HCCA in properly selected patients, was safe and feasible. There were comparable clinical outcomes.
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Objective:To evaluate the short-term efficacy of modified laparoscopic extralevator abdominoperineal excision (L-ELAPE) for ultralow rectal cancer.Methods:The retrospective cohort study was conducted.The clinicopathological data of 60 patients with ultralow rectal cancer who underwent L-ELAPE in the Tangdu Hospital Affiliated to the Air Force Medical University from January 2014 to July 2018 were collected. There were 32 males and 28 females, aged (58±12)years, with a range from 38 to 75 years. Of the 60 patients, 30 patients undergoing modified L-ELAPE were allocated into modified group and 30 patients undergoing traditional L-ELAPE were allocated into control group. For patients in the modified group, the abdominal procedure is the same as the traditional L-ELAPE. The improvements were as follows: (1) when tumor was located in the anterior rectal wall, the patient was plased into the jackknife position before starting the perineal procedure. (2) In order to prevent the small intestine from falling into the presacral space after surgery, the pelvic floor peritoneum was closed under laparoscopy and the biological patch was placed if necessary. For patients in the control group, the whole procedure was performed in the lithotomy position and the biological patch was sutured at the levator ani muscle. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examinations and pelvic computed tomography (CT) examination at 3 months after surgery to assess the small intestine falling into the presacral space up to January 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher′s exact probability. Results:(1) Surgical situations: patients in the two groups completed surgeries successfully, without tranversion to laparostomy or death within 1 month after operation. The operation time, volume of intraoperative blood loss, the number of lymph node harvested, quality score of the whole group specimens, quality score of anterior wall tumor specimens were (359±105)minutes, (192±99)mL, 17±6, 4.1±0.8, 4.7±0.5 for the modified group, respectively, versus (268±37)minutes, (136±61)mL, 15±5, 3.5±0.7, 3.9±0.7 for the control group, respectively. There were significant differences in the operation time, the quality score of the whole group specimens and the quality score of anterior wall tumor specimens between the two groups ( t=2.613, 2.130, 2.871, P<0.05). There was no significant difference in the volume of intraoperative blood loss or the number of lymph node harvested between the two groups ( t=1.521, 0.864, P>0.05). (2) Postoperative situations: the time to first liquid food intake, time to urinary catheter removal, the level of C-reactive protein at the first postoperative day, duration of postoperative hospital stay and cases with perineal complications were (3.3±1.1)days, (8.7±4.8)days, (85±27)mg/L, (8.5±4.5)days and 4 for the modified group, respectively, versus (2.7±1.4)days, (7.7±2.8)days, (79±25)mg/L, (7.7±2.2)days and 5 for the control group. There was no significant difference in the time to first liquid food intake, time to urinary catheter removal, the level of C-reactive protein at the first postoperative day, duration of postoperative hospital stay between the two groups ( t=1.311, 1.520, 0.521, 0.509, P>0.05). There was no significant difference in the perineal complications between the two groups ( P>0.05). All patients with perineal complications were cured after drainage, wound management, nutritional support and extention of hospital stay. (3) Follow-up: all patients were followed up after surgery. The modified group and the control group had 2 cases and 19 cases of small intestine falling into the presacral space showed by the pelvic CT examination at the postoperative 3 months, respectively, showing a significant difference between the two groups ( χ2=21.172, P<0.05). Conclusions:Modified L-ELAPE is safe and feasible for the ultralow rectal cancer, which can provide a better exposure and specimen quality for the tumor located at anterior rectal wall and reduce the incidence of small intestine falling into the presacral space. However, it has longer operation time.
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Objective To understand the negative emotion in primary caregivers of early diagnosed children with acute leukemia. Methods By purposive sampling, 17 cases were selected and investigated by semi-structuredinterviews. Colaizzi principles were used to analyze the data. Results Three themes were extracted:complex emotional response, too many concerns and weak support system. Conclusions The primary caregivers of children with acute leukemia at the early stage of diagnosis have negative emotions such as anxiety and fear, and suffer from psychological and economicpressures.Nurses should provide disease-related nursing skills training and personalized psychological care,and call for the establishment of the social support system and online communication platformto really meet their needs and alleviate the burden of care in order to better meet the follow-up treatment and care of children.
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Objective To investigate the expression of C-MET in papillary thyroid carcinoma(PTC) with (cervical) lymph node metastases, PTC without cervical lymph node metastases,follicular thyroid carcinoma and benign thyroid disease and the clinical significance. Methods The expression level of C-MET was examined by immunohistochemical analysis with C-MET monoclonal antibody in 62 cases of PTC with cervical lymph node metastases, 50 cases of PTC without cervical lymph node mestastases, 10 cases of follicular (thyroid) (carcinoma) and 30 cases of benign thyroid disease. Results PTC with cervical lymph node metastases (expressed) significantly greater level of C-MET than the other forms of thyroid carcinoma and benign thyroid disease(P
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Objective:To observe the activity of urokinase-type plasminogen activator (uPA) in human tongue squamous cell carcinoma cell line Tca8113 under hypoxia in vitro. Methods:According to the different time of hypoxia, the test was divided into four groups as following: (1) 0 h; (2) 6 h;(3)12 h;(4)24 h. The expression of uPA was examined using immunochemistry. The expression of uPA mRNA was examined using in situ hybridization (ISH). The results of ISH staining of uPA mRNA were analysed using Spot and IPP image analysis system.Results:The uPA expression was found in cytoplasm and cytomembrane of Tca8113 cells.uPA mRNA expression was found in cytoplasm of the cells.The staining intensity of uPA mRNA in the groups of (1),(2),(3) and (4) was 0.175 251?(0.013) 863,0.263 191?(0.000 680),0.406 745?0.014 016 and 0.478 919?0.018 998 respectively(P
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Objective To investigate expression of C-MET in palliary thyroid carcinoma(PTC) detected by rapid immunohistochemical analysis and its clinical significance to predicting lymph node metastases.Methods The expression level of C-MET was examined by rapid immunohistochemical analysis with C-MET-EPOS antibody in 85 cases of PTC.Results The rate of cervical lymph node metastates in PTC with strong positive stain expression(95.0%,23/25) was significantly higher than in PTC with positive stain expression(13.4%,8/60)(P