The blood vessels, nerves and the size of the gracilis muscle were studied in 50 adult Chinese cadavers (43 males and 7 females).In average, the length of the gracilis muscles is 325 mm the breadth is 26.18mm the thickness is 6.56mm. The length of its tendon is 112.78 mm.The nutrient arteries of the gracilis muscle may arise from the profund femoral artery, medial circumflex femoral artery, the first perforating artery, femoral artery, popliteal artery, supreme genicular artery or obturator artery. Among them, the profund femoral artery and femoral artery give off constant branches to the gracilis muscle.The dominant nutrient artery of the gracilis muscle arises from the profund femoral artery in 94 cases (94％), from the medial circumflex femoral artery in 5 cases (5％). There is only one case (1％) arising from the first perforating artery.The average length of the dominant nutrient artery is 83.6mm. Its diameter in the origin is 2.24mm. and outside the hilum, 1.44mm. The distance from the vascular hilum to the pubic tubercle is 142.48mm. The surface respresentation of the dominant neuro-vascular hilum is situated at the junction point of the upper and middle thirds of the line joining the pubic tubercle to the adductor tubercle.There are 72.5％ of the dominant nutrient arteries of the gracilis muscle accompanying with two veins and 27.5％, with only one vein.The gracilis muscle is innervated by the anterior branch of the obturator nerve which accompanies the dominant nutrient artery entering the muscle. Its average diameter is 1.78mm.

The satorius muscle,its blood vessels and nerves have been dissected and examinedin 20 Chinese adult cadavers.It was found,on the average,that the length of thesatorius muscle is 529?8.48mm;the breadth,25.30?0.82mm;and the thickness,10.5?0.66mm.The arteries of the satorius muscle may arise from the surperficial circumflex iliacartery (0.66%?0.46),the femoral artery(58.36%?2.82),the deep femoral artery(3.93?1.11),the lateral circumflex femoral artery and its branches(13.44%?1.95),the supreme genicular artery(20.98%?2.33)and the popliteal artery(2.62%?0.91).There may be 5～13 arterial branches,averaging 7.6,in each satorius muscle,distributing roughly and evenly to the whole muscle,with an interval of about 7cmbetween two adjacent arteries and showing segmental distribution.The upper one third of the satorius muscle is mainly supplied by the branchesof the deep femoral artery and the lateral circumflex femoral artery while theinferior one third,by the branches of the supreme genicular artery.Therefore twoisolated flaps may be planned depending on the arteries mentioned above.The satorius muscle is innervated by the femoral nerve.70% of the cases arewith 1～2 branches of nerves,which,before entering the muscle,may give out 1～7twigs.

Objective To investigate the levels of T helper cell 17 (Th17), Th17-related cytokines in-terleukin 17 (IL-17) and interleukin 23 (IL-23) and regulatory T cell (Treg) in relapsing remitting multiple sclerosis (RRMS). Methods In a case-control study, plasma was collected from RRMS patients (n=20) and healthy subjects as control group (n=20). The percentages of Th17 and Treg cells and the levels of IL-17 and IL-23 were tested. The levels of Th17, Treg, IL-17 and IL-23 of the two groups were compared. Patients were treated with methylprednisolone. The levels of Th17, Treg, IL-17 and IL-23 of multiple sclerosis (MS) patients b efore and after treatment were compared. Expanded disability status scale (EDSS) score and the number of Gd-enhancing lesions were evaluated in the case group. Statistical analysis was made by body mass index (IBM) statistical program for social sciences (SPSS) 17.0 software. Independent sample t test was conducted to compare the measurement data of the case group and the healthy control group, and enumeration data were compared by χ2 test; paired sample t test was performed to compare the data of the case group before and after treatment; Pearson correlation analysis was made forthe variables of the MS group before treatment. Results In the RRMS group, the percentage of Th17 cells in peripheral blood was significantly higher than the control group [(2.10±0.45)％vs (1.09±0.20)％](t=9.130, P<0.01), the levels of Th17-related cytokines IL-17 and IL-23 were remarkably higher than the control group (IL-17:t=19.843, P<0.01;IL-23:t=22.747, P<0.01), and the percentage of Treg cells was significantly lower than the control group [(1.33 ±0.30)％vs (2.52±0.30)％], (t=12.422, P<0.01). The levels of Th17 and IL-17 were positively associated with EDSS score (Th17: r=0.458, P<0.05; IL-17: r=0.480, P<0.05), there was no significant-correlation between the level of IL-23 and EDSS score (r=0.368, P>0.05), and Th17, IL-17 and IL-23 were positively correlated with the number of Gd-enhancing lesions (Th17: r=0.446, P<0.05; IL-17: r=0.544, P<0.05; IL-23: r=0.461, P<0.05). The levels of Th17, IL-17 and IL-23 in the RRMS group after the treatment with methylprednisolone were obviously decreased than before treatment (Th17: t=5.747, P<0.01; IL-17: t=9.967, P<0.01; IL-23: t=14.697, P<0.01), while that of Treg was apparently increased (t=10.050, P<0.01). Compared with the control group, the levels of Th17, IL-17 and IL-23 in the RRMS group after treatment were higher (Th17: t=6.889, P<0.01;IL-17:t=7.185, P<0.01;IL-23:t=13.284, P<0.01), and the percentage of Treg was lower (t=7.622, P<0.01). EDSS score of the RRMS group after treatment was remarkably decreased than before treatment(t=6.190, P<0.01), but the number of Gd-enhanced lesions after treatment was no significantiy changed (t=1.453, P>0.05). Conclusion Th17/Treg expression imbalance and Th17-related cytokines IL-17, IL-23 may participate in the pathological process of MS, and they might be therapeutic target for MS.

Objective:To investigate the relationship between sarcopenia and the maximum diaphragm excursion(Dmax)observed on ultrasound in the elderly.Methods:Elderly volunteers(age≥60 years)were recruited from family members of patients at Guangdong Provincial People's Hospital.Their Dmax during forced inhalation was measured via ultrasound.The parameters for the diagnosis of sarcopenia included the appendicular skeletal muscle mass index(ASMI), handgrip strength and usual gait speed.We compared the differences in physical characteristics, pulmonary ventilation, physical performance and Dmax between patients with and without sarcopenia, and evaluated the relationship between sarcopenia and DEmax in the elderly via linear regression.Results:A total of 145 elderly volunteers[age(69.47±5.15)years]were included, and 28(19.31%)were diagnosed with sarcopenia.Body weight, ASMI, maximum inspiratory pressure(Pinmax), maximal power output(Wmax)and Dmax of patients with sarcopenia were significantly lower than those of patients without sarcopenia(all P<0.05).Dmax in the elderly was correlated with sex, height, ASMI, handgrip strength, usual gait speed, Pinmax and Wmax( r=0.181, 0.130, 0.322, 0.373, 0.401, 0.134, and 0.388, P=0.012, 0.037, 0.009, 0.002, 0.022, 0.009, and 0.002, respectively).After adjusting for sex, age, height and forced vital capacity(FVC), there was still a negative correlation between sarcopenia and Dmax in the elderly( β=-0.310, P=0.021). Conclusions:Dmax is related to Pinmax and physical performance in the elderly, and sarcopenia increases the risk of decline in the maximum diaphragm excursion in the elderly as observed on ultrasound.

Surgery is still the first choice for the curation of early gallbladder cancer, and the surgical strategy is selected based on anatomic position of primary tumor, accurate preoperative stage, and strict indication assessment in order to achieve the optimal curative effect. However, most patients are in advanced stage or with distant metastasis at the first diagnosis, and the recurrence rate and 5-year survival rate are not satisfied even if they receive curative resection. Subsequently, it is urgent for the employment of more treatment strategies in the process management of gallbladder cancer patients, such as neoadjuvant therapy, postoperative therapy and first-line or second-line treatment of local advanced and metastatic patients. In recent years, application of molecular targeted agents and immunotherapy have brought greater hope and laid a vaster prospect for the treatment of gallbladder cancer. However, there is still lack of evidence-based medicine data on the prognostic results, and further researches are needed. By integrating the domestic and abroad new research achievements, the authors systematically summarize the current status and future trend on the management of gallbladder cancer, and hope to provide a macroscopic and systemic treatment chart, including necessary details.