Objective To study the influence factors and prevention measures of complication of laparoscopic uter?ine surgery. Methods Patient who underwent laparoscopic uterine surgery were collected (n=415) and divided into hyster?ectomy group (n=310) and myomectomy group (n=105). Intraoperative and postoperative complications such as gastrointesti?nal injury, urinary injury and bleeding were recorded and compared between these two groups. Base on their uterine size, pa?tients were divided into Group A (uterine volume ≤300 cm3), Group B (300 cm3 0.05). The inci?dence of intraoperative or postoperative bleeding was 1.93%(8/415) and incidence of gastrointestinal damage or urinary inju?ry rate was 0.96%(8/415). The incidence of complications in group C was 20.0%(8/40) which is higher than that in group A (2.8%;5/179) and group B (5.1%;10/196). P<0.01 in all cases. The difference between group A and group B was not signif?icant (P>0.05). The incidence in pelvic adhesions group is higher than that in the group without pelvic adhesions [8.3%(15/180) vs 3.4%(8/235), P<0.05]. Conclusion The incidence of complications in laparoscopic myomectomy was higher than that in laparoscopic hysterectomy. When patients were without pelvic adhesions or with uterine volume< 600 cm3, laparo?scopic surgery present least complication.

Objective:To explore the efficacy and safety of intraarterial microguidewire electrocoagulation in arterial aneurysms.Methods:(1) SilverSpeed, a kind of microguidewire used in clinical intravascular treatment for intracranial aneurysms, was used to conduct in vitro electrolysis gas generation experiment with isolated arterial blood of anticoagulant New Zealand white rabbits as medium, and thrombus attachment on the surface of microguidewire was observed under scanning electron microscope. (2) Rabbit common carotid artery aneurysm models were established by using vein bag transplantation method, and divided into microguidewire electrocoagulation treatment groups ( n=40) and blank control group ( n=10). The number of closured tumor cavity and the quality of formed thrombus were observed after electrocoagulation simulation treatment with SilverSpeed microguidewire (charging at 6, 9, 12, 15, and 18 V voltage, respectively for 1, 3, 6, 9, 12, and 15 min). DSA was used to observe whether there was ruptured aneurysms or thrombosis of parent artery. Twelve h later, head MRI diffusion weighted sequence scan was performed to detect whether there were new cerebral ischemia foci in the distal cerebral blood supply area of the parent artery. DSA was performed again 6 months after surgery to observe whether the aneurysms recurred. Results:(1) Electrolytic gas generation experiment results showed that bubbles were generated after electrification of SilverSpeed microguidewire; the higher the voltage, the more severe the reaction. Scanning electron microscope showed that thrombus attached to the surface of the microguidewire after electrification in isolated blood; and the higher the voltage, the denser the thrombus. (2) Under the same charging time, the higher the voltage, the larger the number of closured tumor cavity in rabbits of the microguidewire electrocoagulation treatment groups. Under the same voltage, the longer the charging time, the better the quality of thrombosis. Ischemic events occurred only in the microguidewire electrocoagulation treatment group with voltage>9 V, and the charging duration was not associated with the incidence of embolic events. When the voltage was 15 V, 2 experimental rabbits died due to aneurysm rupture 3 min after electrification. When the voltage was 18 V, 4 experimental rabbits died of cardiac arrest 9 min after electrification, and another 2 rabbits died of aneurysm rupture 6 min after electrification.Conclusions:High voltage is the main cause of adverse events in the microguidewire electrocoagulation treatment of aneurysms. After setting the appropriate voltage, prolonging the electrification time can improve the electrocoagulation effect without increasing the safety risk.

Hypertensive intracerebral hemorrhage (ICH) is mostly single in basal ganglia, thalamus and pons. Simultaneous hemorrhage in other brain regions is relatively rare, accounting for only 5.6% of all hemorrhagic strokes, while bilateral symmetrical hemorrhage is extremely rare. A case of bilateral basal ganglia symmetrical hemorrhage is reported for clinical reference.

Objective:To explore the value and technique details of the overlay reconstruction technique of angiography in surgical planning of scalp arteriovenous fistulas.Methods:The clinical data of patients admitted from February 2014 to April 2020 in the Neurosurgical Department of Second Affiliated Hospital of Soochow University with scalp arteriovenous fistulas were analyzed retrospectively. Preoperative angiography was carried out in all patients for diagnosis, and the angiographical data was obtained without injection of the contrast agent by the mode of XperCT Cereb. Fast HD followed by three-dimension rotation angiography (3DRA) with the contrast agent. The overlay reconstruction was achieved for surgical planning to demonstrate feeding arteries and drainage veins surrounding the fistula. Surgeries were conducted by resection or devascularization of the lesion. All patients were followed up in the out-patient clinic to assess the healing and to detect the symptomatic recurrence and scalp necrosis. The pathological changes of the lesion were observed by HE staining.Results:Five patients were enrolled in this study, including three males and two females aged from 10 to 60 years old (average 34.2-year-old). Pulsatile mass of local scalp was presented in all patients, one with a thin scalp. Five patients suffered from five scalp arteriovenous fistulas, including three on the right side and two on the left. Feeding arteries mainly originated from the superficial temporal artery were confirmed in four cases, and the posterior auricular artery in one case. Single venous drainage was noted in two cases, as well as multiple drainage veins in three cases. Three lesions were supplied by unilateral feeding arteries, while bilateral feeding arteries supplied the rest lesions. Two fistulas were treated by resection, two were treated by devascularization, and one was treated by resection with skin grafting. One lesion was fed by a single artery, three lesions were fed by two arteries, and one lesion was fed by three arteries. Three lesions were fed by unilateral arteries, and two lesions were fed by bilateral arteries. Single fistula was detected in one lesion and multiple fistulas in four lesions. Single drainage was confirmed in two lesions, doubled drainages in two lesions, and tripledrainages in one lesion. All patients experienced surgical treatment in one stage.Two patients underwent complete resection of the lesion, two with complete devascularization, and one with autologous thigh skin grafting after resection. Postoperative pathological examination demonstrated dilated and congested vascular lumen, which was consistent with arteriovenous fistula. All patients healed well after surgery. With13-87 months follow-up, no recurrence and necrosis were noted. Two were reexamined by cerebral angiography, which showed no recurrence.Conclusions:Digital subtraction angiography facilitates the diagnosis of scalp arteriovenous fistula accurately and effectively. The overlay reconstruction technique of angiography is crucial for precise localization of fistula shunt and the surrounding feeders and drainages, which is helpful for surgical planning.

Objective:To explore the value and technique details of the overlay reconstruction technique of angiography in surgical planning of scalp arteriovenous fistulas.Methods:The clinical data of patients admitted from February 2014 to April 2020 in the Neurosurgical Department of Second Affiliated Hospital of Soochow University with scalp arteriovenous fistulas were analyzed retrospectively. Preoperative angiography was carried out in all patients for diagnosis, and the angiographical data was obtained without injection of the contrast agent by the mode of XperCT Cereb. Fast HD followed by three-dimension rotation angiography (3DRA) with the contrast agent. The overlay reconstruction was achieved for surgical planning to demonstrate feeding arteries and drainage veins surrounding the fistula. Surgeries were conducted by resection or devascularization of the lesion. All patients were followed up in the out-patient clinic to assess the healing and to detect the symptomatic recurrence and scalp necrosis. The pathological changes of the lesion were observed by HE staining.Results:Five patients were enrolled in this study, including three males and two females aged from 10 to 60 years old (average 34.2-year-old). Pulsatile mass of local scalp was presented in all patients, one with a thin scalp. Five patients suffered from five scalp arteriovenous fistulas, including three on the right side and two on the left. Feeding arteries mainly originated from the superficial temporal artery were confirmed in four cases, and the posterior auricular artery in one case. Single venous drainage was noted in two cases, as well as multiple drainage veins in three cases. Three lesions were supplied by unilateral feeding arteries, while bilateral feeding arteries supplied the rest lesions. Two fistulas were treated by resection, two were treated by devascularization, and one was treated by resection with skin grafting. One lesion was fed by a single artery, three lesions were fed by two arteries, and one lesion was fed by three arteries. Three lesions were fed by unilateral arteries, and two lesions were fed by bilateral arteries. Single fistula was detected in one lesion and multiple fistulas in four lesions. Single drainage was confirmed in two lesions, doubled drainages in two lesions, and tripledrainages in one lesion. All patients experienced surgical treatment in one stage.Two patients underwent complete resection of the lesion, two with complete devascularization, and one with autologous thigh skin grafting after resection. Postoperative pathological examination demonstrated dilated and congested vascular lumen, which was consistent with arteriovenous fistula. All patients healed well after surgery. With13-87 months follow-up, no recurrence and necrosis were noted. Two were reexamined by cerebral angiography, which showed no recurrence.Conclusions:Digital subtraction angiography facilitates the diagnosis of scalp arteriovenous fistula accurately and effectively. The overlay reconstruction technique of angiography is crucial for precise localization of fistula shunt and the surrounding feeders and drainages, which is helpful for surgical planning.

Purpose: Accumulating evidence has suggested that toll-like receptor 4 (TLR4) is critically involved in the pathogenesis of asthma. The aim of this study was to investigate the role of TLR4 in toluene diisocyanate (TDI)-induced allergic airway inflammation. Methods: TLR4−/− and wild-type (WT) C57BL/10J mice were sensitized and challenged with TDI to generate a TDI-induced asthma model. B-cell lymphoma 2 (Bcl-2) inhibitors, ABT-199 (4 mg/kg) and ABT-737 (4 mg/kg), were intranasally given to TDI-exposed TLR4−/− mice after each challenge. Results: TDI exposure led to increased airway hyperresponsiveness (AHR), granulocyte flux, bronchial epithelial shedding and extensive submucosal collagen deposition, which were unexpectedly aggravated by TLR4 deficiency. Following TDI challenge, TLR4−/− mice exhibited down-regulated interleukin-17A and increased colony-stimulating factor 3 in bronchoalveolar lavage fluid (BALF), while WT mice did not. In addition, TLR4 deficiency robustly suppressed the expression of NOD-like receptor family pyrin domain containing 3 and NLR family CARD domain containing 4, decreased caspase-1 activity in TDI-exposed mice, but had no effect on the level of high mobility group box 1 in BALF. Flow cytometry revealed that TDI hampered both neutrophil and eosinophil apoptosis, of which neutrophil apoptosis was further inhibited in TDI-exposed TLR4−/− mice, with marked up-regulation of Bcl-2. Moreover, inhibition of Bcl-2 with either ABT-199 or ABT-737 significantly alleviated neutrophil recruitment by promoting apoptosis. Conclusions These data indicated that TLR4 deficiency promoted neutrophil infiltration by impairing its apoptosis via up-regulation of Bcl-2, thereby resulting in deteriorated AHR and airway inflammation, which suggests that TLR4 could be a negative regulator of TDI-induced neutrophilic inflammation.

Purpose: Accumulating evidence has suggested that toll-like receptor 4 (TLR4) is critically involved in the pathogenesis of asthma. The aim of this study was to investigate the role of TLR4 in toluene diisocyanate (TDI)-induced allergic airway inflammation. Methods: TLR4−/− and wild-type (WT) C57BL/10J mice were sensitized and challenged with TDI to generate a TDI-induced asthma model. B-cell lymphoma 2 (Bcl-2) inhibitors, ABT-199 (4 mg/kg) and ABT-737 (4 mg/kg), were intranasally given to TDI-exposed TLR4−/− mice after each challenge. Results: TDI exposure led to increased airway hyperresponsiveness (AHR), granulocyte flux, bronchial epithelial shedding and extensive submucosal collagen deposition, which were unexpectedly aggravated by TLR4 deficiency. Following TDI challenge, TLR4−/− mice exhibited down-regulated interleukin-17A and increased colony-stimulating factor 3 in bronchoalveolar lavage fluid (BALF), while WT mice did not. In addition, TLR4 deficiency robustly suppressed the expression of NOD-like receptor family pyrin domain containing 3 and NLR family CARD domain containing 4, decreased caspase-1 activity in TDI-exposed mice, but had no effect on the level of high mobility group box 1 in BALF. Flow cytometry revealed that TDI hampered both neutrophil and eosinophil apoptosis, of which neutrophil apoptosis was further inhibited in TDI-exposed TLR4−/− mice, with marked up-regulation of Bcl-2. Moreover, inhibition of Bcl-2 with either ABT-199 or ABT-737 significantly alleviated neutrophil recruitment by promoting apoptosis. Conclusions These data indicated that TLR4 deficiency promoted neutrophil infiltration by impairing its apoptosis via up-regulation of Bcl-2, thereby resulting in deteriorated AHR and airway inflammation, which suggests that TLR4 could be a negative regulator of TDI-induced neutrophilic inflammation.

AIM: To observe and compare the clinical efficacy and safety of remimazolam and propofol alone and in combination in endoscopic retrograde cholangiopancreatography (ERCP) anesthesia. METHODS: A total of 120 patients undergoing elective ERCP were divided into the propofol group (P group), the remimazolam group (R group), and the remimazolam combined with propofol group (RP group) according to a random number table, with 40 patients in each group, and the three groups completed anesthesia according to the designated drug regimen (propofol in group P; remimazolam in group R; and remimazolam combined with propofol in group RP). General information, operation time and awakening time of the patients in the three groups were compared, as well as oxygen saturation (SpO

Objective: To explore the effects of n-butylphthalide (NBP) on mitochondria in hippocampus and learning and memory abilities in rats with chronic alcoholism. Methods: 60 male SD rats were randomly divided into three groups on average, including normal group, model group and treatment group, with 20 rats in each group.Rats of model group and treatment group are given 6% (V/V) alcohol solution continuously for 28 d to establish the model of chronic alcoholism.Rats in the treatment group were given butylphthalide for 14 days from the fourteenth day after giving alcohol solution.The Y type electric maze was used to test the learning and memory ability of rats, the content of H₂S in the hippocampus and the activity of mitochondrial ATP enzyme were measured by spectrophotometry, and the protein expression of F-actin was detected by Western blot. Results: Compared with the normal group, the learning and memory ability of the rats in the model group were decreased, the content of H₂S in the hippocampus were increased, and the activity of mitochondrial ATP enzyme and the expression of F-actin protein were decreased, and most of the mitochondria were damaged under the electron microscope.The training times of the rats in treatment group(61.88±3.61)was lower than that of the model group(82.19±4.87), the ability of learning and memory was improved(P<0.05). Compared with the model group ((1.50±0.07)U/mgprot, (0.08±0.01)), the activity of the mitochondrial ATP enzyme((1.84±0.11)U/mgprot) and the level of F-actin protein(0.12±0.01)in rat hippocampus of treatment group were increased, the difference was statistically significant(both P<0.05). The level of H₂S in rat hippocampus of the treatment group ((34.56±2.47) nmol/g) was lower than that of the model group ((44.55±3.71) nmol/g), the difference was statistically significant(P<0.05). Compared with model group, the mitochondrial damage of the hippocampus in the treatment group was improved under electron microscope. Conclusion NBP can abate mitochondrial damage and improve learning and memory abilities in chronic alcoholism rats.