Objective To discuss the surgical skills and clinical value of laparoscopic splenectomy with a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen.Methods A total of 88 patients with hypersplenism secondary to liver cirrhosis who underwent laparoscopic splenectomy in our department from September 2015 to September 2016 were selected into this study.And these patients were divided into two groups based on whether to take the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The control group included 40 cases who underwent the traditonal laparoscopic splenectomy,while the observation group included 48 cases who took the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The clinical data were collected retrospectively by medical clinical records review.Results There was no mortality occurred in this study.The blood loss of the observation group was (247.50±135.89)mL,which was obviously lower than (361.75±144.43)mL of the control group,and the difference was statistically significant (P<0.05).The operation time of the two groups were (194.69±47.99)min and (232.75±45.26)min respectively,and the difference was statistically significant (P<0.05).No significant difference was found in terms of rate of conversion to laparotomy,rate of intraoperative blood transfusion,postoperative hospital stay and complications (P>0.05).Conclusion It is very crucial for a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen to establish a tunnel behind the splenic hilum in laparoscopic splenectomy.It is safe and feasible to perform a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The technique is generalized in clinics,especially for freshmen.

Objective To investigate the clinical characteristic and risk factors of corticosteriod-induced ocular hypertension after vitreoretinal surgery.Methods Retrospective analysis was made based on the clinical data of 866 patients,including 126 corticosteriod-induced ocular hypertension(89 male,37 female,age range 9-70 years old) after vitreoretinal surgery during May 2002 to May 2005.Results All cases used glucocorticoid locally or systemically.Multi-variance logistic analysis showed that male,complicated vitreoretinal surgery,longer hospital stay,therapeutic duration with glucocorticoid,cataracta were the independent predictive factors,while myopia,hypertension,diabetes were not closely related to corticosteroid-induced ocular hypertension.Conclusion The incidence of corticosteriod-induced ocular hypertension after vitreoretinal surgery was 14.55%.The important factor leading to ocular hypertension is long-term application of glucocorticoid.

1. Fifty upper limbs of adult cadavers were dissected under an operating microscope.2. The ramus superficialis of the radial nerve is about 180 mm long, and springs from the radial nerve at a level about 16 mm below the medial epicondyle of the humerus. As the radial artery, it can be divided into superficial and deep parts by the overlapping of musculus brachioradialis. The junction between the two parts corresponds to a plane which divides the forearm into upper 2/3 and lower 1/3. The width of the ramus superficialis increases gradually as it runs downwards, and its cross section looks elliptical distally and somewhat circular proximally. Each of the two parts of the ramus superficialis receives 1～4 arteries from the lateral cutaneous arteries or muscular branches of the radial artery. Measurements were made to determine the position of the origin of these arteries.3. The nervus cutaneous antebrachii lateralis divides into two branches in the forearm, and receives 2～8 arteries mainly from the lateral cutaneous branches of the radial artery. It usually gives a branch communicating with the ramus superficialis of the radial nerve. The nervus cutaneous antebrachii lateralis can be found easily at the point just 5～6 mm lateral to the junction of the superficial and deep parts of the radial artery.4. The applied anatomy of the vascular pedicle nerve graft was discussed.

BackgroundOcular melanoma is a malignant tumor with a poor prognosis.To study its mode of pathogenesis and development is helpful for early diagnosis and treatment and improving prognosis. Objective This study was to analyze the location and pathological types of ocular melanoma,and explore the relationship of pathological types with prognosis of ocular malignant melanoma. Methods 110 clinical data and specimens of ocular melanoma were collected at West China Hospital,China.The specimens were examined by hematoxylin & eosin staining,immunochemistry and studying their ultrastructure.The growth location,histological classification,and their relationship with prognosis were analyzed and discussed.The clinicopathological records of the 1 l0 cases with ocular region malignant melanoma treated from January 1980 to December 2007 were analyzed.Results The primary locations of the tumors with respect to the tissue type were:66 cases in the uvea (60.00％ ),27 cases in the ocular surface tissue (24.55％),8 cases in the secondary lesion of orbit cavity (7.27％),7 cases on the eyelid skin (6.36％),and 2 cases in the lacrimal sac ( 1.82％ ).The neoplasm was classified according to pathological types:spindle-cell A type in 31 cases (28.18％ ),spindle-cell B type in 31 cases (28.18％),mixed-cell type in 25 cases (22.73％),epithelioid-cell type in 17 cases ( 15.46％ ) and other type in 6 cases (5.45％).The notability of diffusion or recurrence rate of the 5 pathological types showed statistical significance (x2 =14.463,P =0.006 ),and the rank in decending order was:other type,epithelioid-cell type,mixed-cell type,spindle-cell B type and spindle-cell A type.The clinical manifestations of ocular melanoma were dependent upon the lesion position without specificity.ConclusionsThe majority of the ocular malignant melanoma appears in the uvea and ocular surface tissue,and its common pathological types were spindle-cell type followed by mixed-cell type,epithelioid-cell type and other type.The highest recurrence rate is in other type of ocular malignant melanoma.Ophthalmologist should be aware of the clinical manifestation of ocular malignant melanoma.

Abstract: Objective　To compare the different effects of body mass index (BMI) and lean body mass index (LBMI) on the risk of all-cause death among elderly Chinese individuals. For the more scientific, accurate and convenient measurement of the elderly physique, analysis and evaluation of the health risk factors of the elderly in China. Methods　This study is based on follow-up data from 2014 to 2018, involving 5 990 participants who met the inclusion criteria in the Chinese Longitudinal Healthy Longevity Survey. Participants were grouped according to their BMI and LBMI, and both univariate and multivariate Cox proportional hazard models were established to compare the effects of BMI and LBMI on the risk of death in the elderly. According to gender, age, activities of daily living, and comorbidities, subgroup analysis was conducted to study the influence of LBMI in different subgroups. Results　The study population predominantly comprised females (52.9%, 3 167/5 990), with an average age of (84.7 ± 10.1) years, and most participants lived in rural areas (55.1%, 3 298/5 990). A majority were non-smokers (82.7%, 4 952/5 990) and non-drinkers (84.3%, 5 050/5 990). The prevalence of hypertension was 32.8% (1 966/ 5 990), diabetes 5.6% (334/5 990), and heart disease 12.9% (774/5 990). In the analysis of the impact of BMI on all-cause death in the elderly, univariate analysis showed that an increase in BMI was associated with a reduced risk of mortality. After adjusted by multiple factors (age, gender, living environment, marital status, average arterial pressure, number of children, smoking, drinking, hypertension, diabetes, heart disease, cerebrovascular disease, tumor, ADL/IADL, number of complications), compared to the normal group, the emaciated group (BMI<18.5 kg/m2) had the highest risk of death (HR=1.15,95%CI: 1.01-1.30); the overweight group (24.0 kg/m2≤BMI<28.0 kg/m2) had a lower risk of death (HR=0.78, 95%CI: 0.67-0.91). In the analysis of the impact of LBMI on the risk of death in the elderly, compared to moderate LBMI, lower LBMI was associated with a higher risk of death. Multivariate analysis showed that compared with moderate LBMI, a decrease in LBMI increased the risk of death, whereas an increase in LBMI did not show statistically significant differences in mortality risk in the elderly. Conclusion　In measuring fitness and quality of life in the elderly, LBMI has better representativeness and practical value.

Objective To observe the characteristics of vertical cast-off bloodstain pattern by different hitting-tools. Methods The regular hitting tools, a kitchen knife, a dirk, a plane set-hammer and an iron pipe, were selected. At a distance of 30 cmaway fromthe wall, the hitting tool with 5 mL fresh chick-en blood made the cast-off bloodstain fromtop to bottom. Then the holistic distribution characteristics ( length , width and density ) of cast-off bloodstain and morphology characteristics ( length , width and contact angle) of first single cast-off bloodstain were analyzed. Results The distribution length of cast-off bloodstain formed by dirk was minimum( P<0 .05 ) . The distribution width of cast-off bloodstain formed by kitchen knife was minimum(P<0.05). Except the pair of kitchen knife and plane set-hammer, the distribution density between each two tools had statistical differences (P<0.05). The length of first single cast-off bloodstain formed by plane set-hammer was longest compared (P<0.05). The width of first single cast-off bloodstain had statistical differences between kitchen knife and plane set-hammer, and between dirk and plane set-hammer (P<0.05). Conclusion The type of hitting tool could be inferred by the specific characteristics of cast-off bloodstain pattern formed by every specific type of hitting tool in crime scene.

Objective To explore the clinical application value of combined detection of serum brain natriuretic peptide (BNP),homocysteine(HCY) and blood lipids in the patients with heart failure.Methods The levels of serum BNP,HCY,TC,TG,HDL-C,LDL-C,ApoA,ApoB and Lpa were detected in 100 patients with heart failure (observation group) and contemporaneous 100 persons (control group) undergoing healthy physical examination.Then the comparative analysis was performed.Results Compared with the control group,the BNP and HCY levels in the observation group were significantly increased(P＜0.05);among 7 indicators of the blood lipid,the Lpa level in the observation group was increased compared with the control group,while the TC,HDL-C and LDL-C levels were significantly decreased(P＜0.05),and the TG,ApoA and ApoB levels had no statistical differences between the two groups(P＞0.05).Conclusion Serum BNP,HCY,TC,HDL-C,LDL-C and Lpa levels have close correlation with heart failure,especially the combined detection of BNP,HCY and Lpa,which has predictive and diagnostic value in heart failure and is worthy of clinical popularization and application.

This paper dicusses the significance of drug clinical trials,and summarises the experiences in policy making,personnel trainning,supervising and management in drug clinical trials at the First People's Hospital of Changzhou,which may provide reference for drug clinical trials in China.

Objective To study the effect of nutrition supports in aged mechanically ventilated patients fol-lowing thracic trauma. Methods 48 aged mechanically ventilated patients following thracic trauma were randomly divided into two groups,patients in treatment group( n = 24) received EEN and PN,control group( n = 24) only re-ceived TPN. Compared the nutritional index, time of mechanical ventilation and compared the complications such as windy,intestine paralysis, alimentary tract heorrhage, second heavy infection, hypohepatia and high blood glucose.Results The nutritional index between treatment group and control group had no statistical difference,but the time of mechanical ventilation and the ratio of the complications in control group were higher than that in-treatment group (P < 0.01). Conclusion EEN and PN can improve nutritional condition, have less complieations, promoting the pa-tient recovers form illness.

The rat islets were isolated by using collagenase digestive method, purified by Fi-coll density gradient centrifugation, and rat hepatocytes isolated simultaneously.Twenty-four cas-es of diabetic models, developed in mice with streptozotocin, were divided into 3 groups randomly.In experimental group, donor rat hepatocytes were infused first, followed by transplantation of cultured islets from same donor via portal vein on the 6th day.In Control group 1 no intervention was performed, and in control group 2, simple infusion of islets was done.The results showed group.Significant difference was noted between the two groups(P＜0.05).The decreased blood glucose level were maintained about a week in experimental group.This result reveals that hepa-tocytes can induce immunotolerance and prolong the survival of xenografts to some extent.