Objiective:to summarize the early treatment of severe bifrontal intraparenchyma contusion associated with central herniation. Mehthod:clinical presentation of 41 cases of secere bifrontal contusion associated with central herniation were analyzed retrospectively. Resolts:12 cases had good overcome,13 mild morbidty,2 severe mordity,1 were in persistent vegetative state,3 mortality.Conclusions: Attaches great importance to patients with severe bifrontal brain contusion associated with central herniation,close observation of patients with their consciousness,pupil and changes in vital signs;attend that it is premature to stop dehydrating agent,too fast,to review the head dynamic CT,the right to master surgical indications.Early removal of necrotic brain tissue and cranial decompressive craniectomy to be effective in improving the cure rate of patients.

Objective To investigate the impact of the different mode of delivery on postpartum lactation.Methods 1 678 pregnant women in our hospital were divided into cesarean section group(798 cases) and natural delivery group(880 cases).Open milk after delivery,breast fullness,the number of neonatal sucking and post-natal self-assessment milk water were compared between the two groups of pregnant women,and the impact of the mode of delivery on postpartum lactation was analyzed.Results Whether or not began to lactation (721/77cases),and the time of labor to beginning to lactation [(33.45 ± 9.68) h],and whether or not having breast fullness feeling (512/286 cases),and the time of labor to breast fullness feeling[(57.12 ± 13.90) h] in cesarean section group had significant difference with those of spontaneus labor group [(845/35 cases),(30.12 ± 10.25) h,(690/190 cases),(52.98 ±15.09) h] (x2 =21.613,t =2.452,x2 =41.813,t =2.818,all P ＜ 0.05).There was no significant difference in selfrating milk score [(2.02 ± 0.45) points vs (2.45 ± 0.51) points],and newborn sucking times 4 ～ 6d postpartum [(5.21 ±1.21) times vs (5.89± 1.82)times](t =2.012,2.532,all P ＜0.05).Conclusion Efficiency of the breast-feeding was affected by the impact of the mode of delivery.Rationalized breastfeeding guidance was necessary to strengthen for pregnant women by cesarean section.

Objective To systematically analyze therapeutic effects of extracorporeal photopheresis (ECP) on refractory steroid-resistant,-dependent or-intolerant graft-versus-host disease (GVHD),to compare remission rates of skin GVHD in detail.Methods Databases were searched for studies concerning remission rates of GVHD after the treatment with ECP,and relevant data were extracted and pooled by using meta-analysis with STATA 12.0 software.Results A total of 22 literatures were reviewed,including 787 patients with refractory GVHD.Meta-analysis showed that the pooled complete remission (CR) rate and overall remission (OR) rate were 57％ (95％ CI:47％-66％) and 79％ (71％-86％) respectively in patients with acute GVHD,27％ (21％-33％) and 63％ (58％-69％) respectively in patients with chronic GVHD,77％ (71％-82％) and 87％ (82％-91％) in patients with acute skin GVHD,as well as 39％ (30％-48％) and 70％ (63％-77％) in patients with chronic skin GVHD.Conclusion ECP is an effective therapy for refractory GVHD,especially for skin GVHD.

Infectious necrosis is one of severe local complications caused by acute pancreatitis,and the mortality rate was reported to be up to 10％ ～ 20％.Traditional open surgical debridement used to be the sole option for this disease.Nevertheless,this approach is associated with poor outcome.Currently,conservative treatment and minimally invasive procedures are more favorable.The treatment for infectious necrosis caused by acute pancreatitis can be summarized as 3D,representing delay,drain,debride.The patients usually receive initial treatment in ICU division,and surgical intervention is then delayed.Percutaneous drainage can be firstly performed in the early course of the disease,followed by necrotic tissue debridement with laparoscopic or video-assisted retroperitoneal procedures.Open surgical debridement is now rarely used,which is merely performed for certain refractory cases.The management of acute pancreatitis infected necrosis therefore is a clinical question that requires a multiple disciplinary team rather than a simply surgical disease.This paper reviewed the relevant issues.

In recent years,with the continuous development of endoscopic and interventional techniques,many new devices and methods have been used in clinical practice,and the application of endoscopic retrograde cholangiopancreatography (ERCP)in biliary and pancreatic diseases has developed rapidly.This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases,including those with altered gastrointestinal anatomy,pregnant patients,patients with benign and malignant biliary strictures,and patients with pancreatic pseudocysts,as well as the application of SpyGlass,photodynamic therapy,and radiofrequency ablation,the man-agement of ERCP-related duodenal perforation,and the prevention of post-ERCP pancreatitis.All the progress has made a great contribu-tion to the diagnosis and treatment of biliary and pancreatic diseases.

AIM: To study whether there was a correlation between central foveal thickness (CFT) assessed with optical coherence tomography (OCT) and visual acuity of patient with high myopia after phacoemulsification and intraocular lens implantation.METHODS: Totally 67 patients with high myopia underwent phacoemulsification and intraocular lens implantation were enrolled in the study.Best corrected visual acuity (BCVA) was recorded and CFT was measured using OCT at 1wk,1 and 3mo after oerations.BCVA and CFT were compared before and after the operation.All patents were divided into two groups by the BCVA at 3mo after operation,BCVA>0.5 in Group A and BCVA≤0.5 in Group B.ANOVA,Spearman correlation analysis and independent t test were used for statistical analysis.RESULTS: There was a statistically significant difference between preoperative BCVA and postoperative BCVA (F=115.04,P<0.01).Preoperative CFT was different compared with that 1wk and 1mo after operation (P=0.04,0.02) and was not different with that 3mo after operation(P=0.52).There was a statistically significant difference in CFT of postoperative 3-month compared with that of postoperative 1-week(P<0.01) or that of postoperative 1-month (P<0.01).BCVA showed significant positive correlation with CFT without foveal lesion on postoperative 3mo (r=0.28,P=0.03).CFT of Group A and Group B was significantly different at 3mo after the operation (t=-2.24,P=0.03).There was no significant difference in age and intraocular lens of two groups.CONCLUSION: Optical coherence tomography allow for objective assessment of retinal construction changes in eyes with high myopia are correlated to visual acuity.

Objective To investigate the difference of TCM body constitution betweenpeople of the Shimian county and Chengdu city. Methods 200 sub-health patients in clinic of Shimian TCM Hospital were selected randomly. Another 200 sub-health patients in clinic of the Second Sichuan Province Hospital of TCM wererandomly selected. The two groups were identified with TCM body constitution based on the clinical symptoms, tongue, pulse condition, etc. Comparisons on body constitution were made between the two groups. Results In Chengdu, patients withbalance constitution and Qi deficiency constitution (respectively have the proportion of 33.0% and 20.0%)were significantly higher than thoseof Shimian County(the proportion of the two wererespectively 4.0% and 6.0%);while Shimian County have a significantly higher ratio of phlegm dampness and blood stasis constitution(43.5% and 13.0%)than those in Chengdu city(the proportion of the two wererespectively 8.0%and 4.0%), P<0.01. Conclusion Because of different regions, the population constitution ratio wasdifferent, so the disease tendency wasalso somewhat different. Therefore, physicians should give full consideration to the regional factors in diagnosing and treating patients.

Objective To investigate the diagnostic method,microsurgical operation time and effect of brain arteriovenous mal-formation(AVM)rupture hemorrhage in childhood.Methods 72 children (≤16 years old)of AVM hemorrhage from 2003 to 2013 were retrospectively analyzed.Results The CT diagnosis rate was 48.6%(35/72),the MRI diagnosis rate was 78.3%(47/60),56 cases were performed the early whole brain DSA under the condition permitting,its diagnosis rate was 98.2%(55/56).All the cases were performed the hematoma clearance plus the pertinent lesion resection.70 cases were re-examined by DSA/CTA/MRA during postoperative perioperation period.The lesion resection rate was 91.5%,the partial resection rate was 8.6%.60 cases(85.7%) were successfully followed up for 6 months to 6 years and assessed by the Glasgow outcome scale,5 points in 5 5 cases,4 points in 2 cases,3 points in 2 cases and 2 points in 1 cases.Conclusion DSA is the main detection measure for early diagnosing AVM hem-orrhage and the microsurgical operation in the acute stage can reduce the fatality and improve the prognosis.

LI-cadherins are a new member of cadherin superfamily,which transmembrane glycoproteins mediate Ca2 + dependent cell-cell adhesion independent of cytoplasmic interactions.They play an pivotal role during tissue development and are critical for the maintenance of junctional complexes between cells and tissues,LI-cadherin high expression in hepatocellular carcinoma results in the decrease of intercellular adhesion effect,cause hepatocellular carcinoma metastasis.

Continuous renal replacement therapy( CRRT) employs convection and adsorption to re-move pro-and anti-inflammatory mediators from plasma, helping to restore the immunologic homeostasis. CRRT also provide uninterrupted clearance of retained endogenous and exogenous toxins, along with acid-base,electrolyte,hemodynamics and volume homeostasis.CRRT may improve outcomes in critically ill pa-tients with sepsis-induced acute kidney injury,septic shock and multiple organ dysfunction syndrome.Region-al citrate anticoagulation, as compared to unfractionated heparin, report better filter survival times and less bleeding.Antibiotic dosing decisions should be individualized to take into account patient-related,CRRT-relat-ed,and drug-related factors.