OBJECTIVE To discuss the common problems and their management in the endoscopic nasal dacryocystorhinostomy(DCR) for recurrent dacryocystitis.METHODS A total of 44 patients with recurrent dacryocystitis were performed in our hospital from July,2003 to July,2008.The clinical data of all the cases were studied.All the cases were followed up for over 6 months.RESULTS The common problems met in the operation according to the occurrence frequency were bleeding,difficult for localizing the lacrimal sac,the size and the location of the bony ostium,the size of lacrimal ostium and sinonasal diseases.The cure rate was 93.18%(41/44). CONCLUSION Special instruments,skillful handling and familiar with intranasal anatomy of the lacrimal sac area are the keys to improve the successful rate of endoscopic nasal dacryocystorhinostomy.

Objective To analyze the clinical effect of probucol in prevention of contrast induced nephropathy(CIN) after percutaneous coronary intervention(PCI).Methods 96 patients with coronary heart disease requiring PCI surgery in our hospital were selected as the research subjects, and they were randomly divided into control group(48 cases) and observation group(48 cases).Both two groups were given traditional treatment, besides this, the observation group was given additional probucol (3 d treatment before and after operation,0.5 g/time,2 times/d).The renal function indicators such as serum creatinine (Scr), cystatin C(CysC), blood urea nitrogen(Bun), estimated glomerular filtration rate(eGFR), and the expression levels of C-reactive protein(CRP),interleukin-6(IL-6) and malondialdehyde(MAD) in the two groups 24 h,48 h, 72 h before and after PCI were observed and compared.And the adverse reactions during operation in the two groups were also recorded and compared.Results There were no significant differences in Scr,CysC,Bun and eGFR between the two groups before opertion(t=0.149,P=0.882;t=1.75,P=0.243;t=0.019,P=0.985).12 h after operation, the Scr,CysC,Bun and eGFR levels in the two groups were gradually increased,48 h post-treatment, the levels reached to the peak and showed a downward trend 72 h after operation;compared with the control group, the rise and decline in the observation group were more greater, and the differences were statistically significant (t=3.242,P=0.002;t=9.532,P<0.001;t=9.073,P<0.001;t=2.896,P<0.001).There were no significant differences in CRP,IL-6 and MAD between the two groups before operation (t=0.321,P=0.749;t=0.014,P=0.989;t=0.188,P=0.850).24 h after operation, the CRP,IL-6 and MAD levels in the two groups were gradually increased,48 h post treatment, the levels reached to the peak and showed a downward trend 72 h after operation;compared with the control group, the rise and decline in the observation group were more greater, and the differences were statistically significant (t=8.495,P=0.002;t=7.532,P<0.00;t=16.216,P<0.001).There were no obvious adverse reactions during operation in the two groups.Conclusion Probucol not only has lipid-regulating and atherosclerotic effects on patients with coronary heart disease, but also has certain preventive and clinical effects to CIN after PCI.Thus, it can be considered as a preferred drug for clinical prevention and treatment of CIN.

Objective To investigate the prevalence and influencing factor of metabolic syndrome(MS)in rural elderly population. Methods With randomized cluster sampling,investigations including questionnaires,physical examination,fasting plasma glucose,blood lipids were performed in rural population aged over 60 years in Changzhou city in 2004-2005. Results A total of 4976 elderly people were enrolled in the study.The prevalence of MS was 24.1%,and 10.3%in men,34.3%in women by international diabetes federation(IDF)2005 definition.86.2%individuals had one or more of the metabolic disorders.Logistic regression analysis showed that sex,smoking,sweetmeat,family history of essential hypertension(EH)and tea drinking were influencing factors of MS. Conclusions The prevalence of MS is high in rural elderly population,especially in females.

Objective To explore the status of C57BL/6J mouse brown fat adipogenic differentiation function with aging.Methods C57BL/6J female and male mice at the ages of 0-week (newborn),4-week,8-week,12-week old were selected from the same brood,brown adipose tissue was obstained from their interscapular region,and the brown adipose was identified by using immunohistochemical markers.Then the total RNA was extracted from the brown adipose and quality identification was determined at the same time.The expression levels of the related genes (PPARα,C/EBPα,PGC-1α,PPARγ,FOXC2,BMP7) induced by brown adipose adipogenic differentiation were detected by quantitative real-time PCR in 0-week,4-week,8-week,12-week mice.Results Uncoupling protein -1 (UCP1) immunohistochemical data indicated that positive deep-colour substance was brown adipose tissue.Quantitative Real-time PCR also indicated that the expression volume of adipogenesis gene gradually reduced with aging,and there were significant differences at the different time points [PPARα (F =11.96,P ＜ 0.000 1),C/EBPα (F =9.39,P ＜0.000 1),PGC-1α(F =17.21,P ＜0.000 1),PPARγ(F =13.11,P ＜0.000 1),FOXC2(F =12.23,P ＜0.000 1),BMP7(F =16.44,P ＜0.000 1)].Conclusions The adipogenic differentiation ability and activity of mouse brown adipose gradually reduce with aging.But the regulatory factors for its function needs to be further investigated.

Objective To analyze the influencing factors of deep vein thrombosis (DVT ) in the patients with abdominal trau‐ma .Methods A total of 200 cases of patients with abdominal trauma in our hospital from June 2014 to June 2015 were selected and performed the color Doppler ultrasonography for determining whether DVT occurring .The clinical data were retrospectively ana‐lyzed .The influencing factors of DVT occurrence in the patients with abdominal trauma were analyzed .Results Among 200 cases of abdominal trauma ,56 cases appeared the symptoms and signs of muscular pressing pain ,swelling pain ,positive Homans sign ,su‐perficial varicose and skin temperature decrease within 7 d after abdominal trauma ,60 cases were diagnosed as DVT by color Doppler ultrasonography .The multivariate Logistic regression analysis results showed that advanced age ,high cholesterol level ,high D‐dimer level ,high blood urea nitrogen level ,complicating hypertension ,complicating diabetes ,complicating hyperlipidemia ,surgical history at preoperative 1 month ,lower abdominal trauma ,high score of trauma ,bedridden time more than 3 d and infection were the independent risk factors of DVT occurrence in abdominal trauma patients (P<0 .05) .Conclusion Clinic should perform the color Doppler ultrasound screening in the abdominal trauma patients with risk factors of DVT ,which is conducive to early discovery and early treatment of DVT .

Intertrochanteric fracture is the most common hip fracture. Due to severe osteoporosis and high degree of fracture comminution, initial implant failure or nonunion occasionally occurs. It is still controversial how to formulate a more effective strategy for revision and fixation after failed primary operation for patients who have high functional needs and/or long-life expectancy. Common surgical procedures include angle-stabilized extramedullary plate systems (dynamic condylar screw or dynamic hip screw), cephalomedullary nail systems (proximal femoral nail antirotation, InterTAN, and trochanteric fixation nail advanced) with/without medial augmentation plate. For patients with intertrochanteric fracture who have suffered from primary operation failure, the basic principle for revision is to mechanically reconstruct the stable triangular structure of the proximal femur in order to improve the mechanical stability of the fracture ends as much as possible so that fracture healing and early functional exercise can be ensured. This paper reviews the clinical and biomechanical studies published, analyzes the mechanical factors responsible for failure of initial surgery, summarizes revision strategy and clinical prognosis, and provides our clinical experience and technical innovations, hoping to help clinicians in choosing an optimal revision strategy.

Objective:To explore the causes and preventive measures of early complications after free gracilis muscle transfer in reconstruction of brachial plexus injury, and to improve the postoperative function of the transferred gracilis muscle.Methods:Patients were recruited from August, 2005 to December, 2016. All 111 patients of brachial plexus injury underwent reconstructive surgery using 122 free gracilis flaps. Early postoperative complications, including recipient site, donor site and systemic complications, were closely observed and recorded. Outcome measurements included incidence and timing of flap compromise, type of flap compromise, causes of vascular occlusion and salvage rate. The postoperative strength of gracilis was evaluated according to the BMRC score. The data were statistically analyzed. The difference was statistically significant if P<0.05. Results:The survival rate of 122 free gracilis transfers was 98.4% (120/122). Early complications occurred in 32 cases (including 2 complications in 6 patients) : 27 cases with recipient site complications (84.4%), 4 with donor site complications and 7 with systemic complications. Among the 32 cases of complications, 17 flap compromises caused by vascular obstruction and 15 of them were salvaged completely after exploration. Flap crisis was the main issue that affected the postoperative function of gracilis muscle, and 58.8% (10/17) of patients with vascular crisis showed muscle strength above M 3 after surgery. The main causes of vascular crisis were venous tortuosity and venous thrombosis, which had nothing to do with operation time and intraoperative blood loss. Conclusion:Flap crisis is the main factor affecting the postoperative function of gracilis. The rate of flap salvage can be tremendously increased by early detection, re-exploration and effective management of the flap crisis.

Objective To investigate the clinical effects of endoscopic sphincterotomy (EST) or endoscopic retro-grade cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) combined with la-paroscopic treatment of gallbladder and common bile duct stones. Methods 80 patients suffered cholecystolithiasis with choledocholithiasis were selected from June 2013 to June 2015. According to surgical method, patients were di-vided into EST + LC group (38 cases) and LCBDE + LC + ERCP group (42 cases). Clinical data, treatment effects, postoperative complications rate related indicators of liver function were compared between the two groups. Results The maximum diameter of stones, diameter of common bile duct and the number of stones in LCBDE + LC + ERCP group were significantly longer and larger than EST + LC group, the differences were statistically significant ( <0.05). Compared with EST + LC group, single success rate of ERCP + LC + LCBDE group was higher, operative time was shorter, but its operation cost was higher, the differences were statistically significant ( < 0.05). The suc-cess rate, rate of conversion to laparotomy and hospital stay between the two groups showed no significant difference ( > 0.05). Postoperative complication rate of ERCP + LC + LCBDE was 21.42 %(9/42), and postoperative compli-cation rate of EST+ LC was 26.32 % (9/42), the difference between the two groups were not clear ( > 0.05). The serum direct bilirubin, alanine aminotransferase and aspartate aminotransferase in the two groups were increased slightly after one day of operation, and those indexes returned to normal levels after three days of operation. Conclusion The operation methods of LCBDE+LC+ERCP and EST+ LC are both effective treatment for compli-cated choledocholithiasis. The success rate of LCBDE+LC+ERCP is higher, the operative time is shorter, which is good for larger stones.

Objective To probe the indication of biliary tract reconstruction without T-tube in orthotopic liver transplantation.Methods We put forward indications of biliary tract reconstruction without T-tube in orthotopic liver transplantation since January 2004 and there were 102 patients who underwent liver transplantation in our hospital without a T-tube in place after biliary tract reconstruction.The incidence of biliary tract complication was observed in these patients.Results All patients were followed up for more than 6 months.The incidence of biliary tract complication was 4.9 percent(5/102)in this group with 3 patients of intrahepatic difluse bile duct stenosis necessitating liver re-transplantation.The other 2 patients with common hepatic duct nonanastomotic stenosis were healed by ERCP plus stent placement.Conclusions Biliary tract reconstruction without T-tube placement helps to decrease the incidence of biliary tract complications resulting from the T-tube removal.

Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.