Objective To discuss the indications,technical skills and the therapeutic effects of percutaneous lumbar diskectomy(PLD) for the treatment of lumbar intervertebral disc herniation in patients over 70 years.Methods From August 2004 to July 2008,PLD was performed in 48 patients(aged 70-79) with lumbar intervertebral disc herniation.A total of 58 lumbar intervertebral disc herniations were detected,all of which were encapsulated intervertebral disc herniation.Fifty-two patients,who showed similar symptoms,signs and same imaging manifestations and were 70-81 years old,were randomly selected as control group to receive conservative treatment.Results Of 56 lumbar intervertebral disc herniations,54 were successfully punctured with a successful rate of 96.4%.All patients were followed up.The excellent rate and the effective rate at 6 months were 29.1% and 52.1% respectively for PLD group,while that were 19.2% and 36.5% respectively for control group.The excellent rate and the effective rate at 12 months were 25.0% and 47.9% respectively for PLD group,while that were 17.3% and 32.7% respectively for control group.At both 6 and 12 months after the treatment,the therapeutic effects of PLD group were significantly better than that of control group,the difference were statistically significant(?2=7.45,P

Objective To explore the effect of prevention and treatment of external application of Algoplaque for controlling phlebitis caused by peripheral indewelling needle in vein for patients. Methods This research was divided into two parts,prevention and treatment. As for prevention research,patients were randomly divided into the experimental and the control groups,each group included 30 patients. In the experimental group,we applied directly external application of Algoplaque at the upper of needle puncture site of the vein and nearby the eye. In the control group,we applied the film directly to fix the indwelling needle. As for the treatment research, it was carried out in patients with occurred phlebitis, who were randomly divided into two groups,the experimental group included 30 cases of patients and the control group included 28 cases of patients. Observation time was one to five days. Results The incidence of phlebitis in the experimental group of prevention research was 23%, in the control group it was 90%. The incidence of phlebitis in the experimental group was significantly lower than that of the control group. The effective rate in the experimental group of treatment research was 96.7% and it was 67.9% in the control group. The difference was very significant. Conclusions External application of Algoplaque can effectively control phlebitis caused by peripheral indewelling needle in vein.

AIM:To investigate the expression and potential role of complement 5a receptor (C5aR) in chro-nic graft-versus-host disease (cGVHD).METHODS:The expression of C5aR on lymphocytes and the frequency of CD4+CD25+ Foxp3+ regulatory T cells (Tregs) in 20 cGVHD patients and 9 healthy donors was detected by flow cytometry.The correlation between the expression of C5aR and the percentage of Tregs in the cGVHD patients was analyzed.In addition, the splenocytes from the mice were cultured in vitro, and stimulated these splenocytes with recombinant mouse C5a protein (rmC5a).The peripheral blood mononuclear cells (PBMCs) from cGVHD patients were cultured in vitro, which was inhibited by C5aR antagonist (C5aRA).The frequency of Tregs in these splenocytes and the PBMCs were evaluated by flow cytometry.RESULTS:The expression of C5aR on the lymphocytes was significantly increased in the cGVHD patients compared with the healthy donors, while the percentage of Tregs was markedly lower in the cGVHD patients.The expression of C5aR was negatively correlated with the percentage of Tregs.Furthermore, the development of Tregs was suppressed by rmC5a stimulation, but was promoted by C5aRA in vitro.CONCLUSION:C5aR elevation is associated with Treg reduction in cGVHD, indicating that C5aR may play a potential role in suppressing Tregs, resulting in the incidence of cGVHD.

Objective :To explore the clinical value of serum C reactive protein (CRP) combined with hematocrit (Hct) in prediction of severe acute pancreatitis(SAP) .Methods :Seventy five patients ,who were admitted due to AP during April 2011 and December 2014 ,were enrolled .The levels of CRP and Hct ,which were determined within 24 h after admission ,were compared between the patients with SAP and those with mild acute pancreatitis (MAP) .The diagnostic efficiency of CRP combined with Hct in early prediction of SAP was evaluated by ROC curve .Results : The levels of CRP and Hct in SAP group were significantly higher than those in MAP group (P< 0 .05) .The sensitivities of CRP and Hct in the diagnosis of SAP were 61 .56% and 49 .57% ,respectively . The specificities were 83 .27% and 80 .23% ,respectively . And the positive predictive values were 53 .52% and 40 .35% ,respectively .Furthermore ,the negative predictive values were 90 .37% and 85 .26% , respectively .The sensitivity of CRP combined with Hct in diagnosis of SAP was 51 .23% .The specificity was 94 .29% .And the positive predictive value was 76 .12% . Furthermore , the negative predictive value was 87 .23% . Conclusions : CRP combined with Hct is conducive to early diagnosis of the severity of AP .Thus ,it is worthy of clinical practice .

Objective: To investigate the effects of artesunate treatment on chronic graft-versus-host disease (cGVHD). Methods: Recipient BALB/c mice received 8 × 10⁶ bone marrow cells with 8×10⁶ spleen cells from B10D2 mice. Artesunate solubilized in acetone was injected intraperitoneally every day at the dose of 1 mg/kg at Day 28 after BMT. The clinical scores, survival and histopathological damage were analyzed. The frequency of Th17 and Tregs in PB and spleens from the mice were evaluated by flow cytometry. In addition, CD4⁺ T cells from the spleens of mice were cultured in vitro, then stimulated with artesunate, the frequency of Th17 and Tregs in these splenocytes were evaluated by flow cytometry. Results: Artesunate administration diminished clinical and histopathological damage, and improved the survival of cGVHD mice[(46.57±7.83)% vs (55.71±6.99)%, χ²=5.457, P=0.020]; Artesunate contributed to Tregs development [(4.45±0.04)% vs (8.40±0.23)%, t=15.679, P<0.001; (6.62±0.24)% vs (10.48±0.48)%, t=6.587, P=0.003] while decreased Th17 cells [(1.51±0.18)% vs (0.58±0.19)%, t=7.233, P<0.001; (1.48±0.38)% vs (0.71±0.18)%, t=3.653, P=0.011] expressions in both PB and spleens, and decreased the Th17/Treg ratio (0.34±0.05 vs 0.09±0.03, t=7.621, P=0.002; 0.19±0.03 vs 0.06±0.02, t=6.993, P=0.002). Moreover, artesunate suppressed the Th17 cells expressions [(0.82±0.37) % vs (3.39±1.22) %, t=4.044, P=0.007] and contributed to Tregs development [(34.63±1.29) % vs (14.28±1.69) %, t=19.119, P<0.001], and also decreased the Th17/Treg ratio (0.24±0.09 vs 0.02±0.01, t=4.780, P=0.003) in vitro. Conclusions Artesunate suppressed the Th17 cells expressions and contributed to Tregs development, which provided new sights into the development of a novel drug for cGVHD, e.g., artemisinin.

Airway management in complex tracheobronchial surgery(TBS)remains a challenge in thoracic sur-gery.The use of extracorporeal membrane pulmonary oxygenation(ECMO)in thoracic surgery is rather rare,except for lung transplantation.To report the safety and efficacy of ECMO in complex TBS,a total of 5 patients with tracheobronchial and bronchial reconstructive surgery supported by ECMO in the Department of Thoracic Surgery of Tangdu Hospital,Air Force Medical University from May 2019 to June 2024 were collected.Among them,4 cases of tracheal tumor(including long-segment trachea resection and reconstruction,or carinal resection and reconstruction)and 1 case of acute airway obstruction caused by tracheal rupture were included,all of which were performed in veno-venous ECMO(V-V ECMO)mode.Systemic heparinization was used in 2 patients,and anticoagulation was not performed in 3 patients,which were maintained only by ECMO heparin-coated lines.4 patients recovered well after surgery,and 1 patient died 1 month after surgery due to immune-related pneumonia.For complex TBS,or in emergency situations(tracheal stenosis with risk of asphyxiation),ECMO can pro-vide adequate support and safeguard.

Objective:To investigate the value of magnetic resonance cholangiopancreatography(MRCP)in the evaluation on Calot’s triangle adhesion before laparoscopic cholecystectomy(LC).Methods:A total of 254 patients received MRCP before LC,and the type of Calot’s triangle adhesion was evaluated,which included whether or not the cystic duct had been displayed, adjacent relations between the cystic duct and the gallbladder ampulla,and the open position of the cystic duct in the gallbladder ampulla.The type of Calot’s triangle adhesion by preoperative evaluation was compared with that by intraoperative findings. The relation between the type by preoperative evaluation and the difficulty of operation was analyzed.Results:The type of Cal-ot’s triangle adhesion by preoperative MRCP corresponded with that by intraoperative findings.The rabbit tail type of adjacent relation between the cystic duct and the gallbladder ampulla,the cystic duct starting at the middle portion of the gallbladder am-pulla and the absent imaging of cystic duct could indicate difficult LC procedures.Conclusions:MRCP could be used in preoper-ative evaluation on Calot’s triangle adhesion,to predict the difficulty degree of the LC procedure.

The febrile respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the focus of global attention. Up to now, the infection has been continuing to spread all over the world and it is urgent to develop specific drugs for SARS-CoV-2. Finding effective and safe drugs which are already available in the market for treating coronavirus disease 2019 (COVID-19) is one of the main strategies to solve the problem in time. As quinoline alkaloids against malaria, chloroquine and hydroxychloroquine have been proved to have the anti-SARS-CoV-2 activity. Quinoline alkaloids are expected to be important drugs for the treatment of COVID-19. In this article, the research and application of chloroquine and hydroxychloroquine are reviewed from the aspects of pharmacokinetics, drug interaction, clinical research progress, treatment plan optimization and resolution of optical enantiomers. The possible problems are summarized in order to provide reference for further research and clinical application of quinoline alkaloids in the treatment of COVID-19.

Objective:To understand the progression of CD 4+ T cells (CD 4) declining rate in different age groups among MSM and to further explore the pathogenesis of HIV infection. Methods:Data regarding MSM who were diagnosed as HIV positive, aged ≥15 years, with homosexual route of transmission and with more than two records of CD 4 count retained before antiretroviral therapy (ART), were collected from the National AIDS Comprehensive Prevention Information System until May 31, 2019. Linear mixed effect model was used to fit the linear elimination relationship between the square root of CD 4 cell count and infection time before taking up the ART. To get the intercept estimation, we used the results from CD 4 count which containing the dates of last negativity and first positivity on HIV antibody testing. Both t test and Z test were used to test the model parameters. Median intervals from HIV seroconversion to CD 4<500, <350, <200 cells/μl were estimated. Results:A total of 26 754 individuals were included in the study including 146 of them having records on the last date of being test negative. Their median age was 27 years old ( M=27, P25- P75:23-35). The intercept of the liner mixed models among 15-, 25- and ≥35 year olds were 24.84 (95 %CI: 23.76-25.92), 23.94 (95 %CI: 22.86-25.02), 23.44 (95 %CI: 21.91-24.96) and the slope of the liner mixed models among the 15-24, 25-34, 35-44 and ≥45 year olds were -1.31 (95 %CI: -1.33--1.25), -1.37(95 %CI: -1.40--1.33), -1.53 (95 %CI: -1.58--1.47) and -1.59 (95 %CI:-1.68--1.51), respectively. Estimation on the median intervals from HIV seroconversion to CD 4 <500, <350, <200 cells/μl counts were 1.29 (95 %CI: 0.79-1.81), 3.92 (95 %CI: 3.36-4.48) and 7.21 (95 %CI: 6.58-7.81), respectively. The median time of 15-24 age group from HIV seroconversion to reach the three CD 4 thresholds appeared the longest, as 1.89 (95 %CI: 1.05-2.85), 4.68(95 %CI: 3.80-5.77) and 8.17 (95 %CI: 7.23-9.42) years, respectively, the median time of ≥45 age group from HIV seroconversion to reach the three CD 4 thresholds appeared the shortest, as 0.68 (95 %CI: 0.00-1.72)、2.98 (95 %CI: 1.91-4.14)、5.85 (95 %CI: 4.62-7.16) years, respectively. Conclusions:Our findings suggested that the CD 4 declining rate had been accelerated along with ageing. Progression time from HIV seroconversion to different CD 4 thresholds appeared different, which was shorter in the older age group. Again, these findings showed the great impact of HIV infection among older age groups in the MSM population. Early diagnosis and treatment were bound to delay the progression of the disease.

Objective:Using the changing patterns of CD 4+ lymphocytes (CD 4) counts of HIV/AIDS cases, we tried to estimate the number of newly infected HIV in Honghe Hani and Yi autonomous prefecture (Honghe prefecture) Yunnan province, and to provide reference for evaluating the trend of local HIV epidemic. Methods:Among diagnosed HIV infections, those who were at ≥15 years old, having available initial CD 4 records of testing, initiating antiviral therapy before the end of 2018, were selected from the case reporting system of Honghe prefecture, Yunnan province. Both Depletion model of the square root on CD 4 and the time of infection were used to back-calculate the seroconversion time of each individual. Both direct probability distribution method and life table method were used to calculate the distribution rates of diagnosis and the weight of delay. The number of diagnoses over the years was used to reversely estimate the total number of newly HIV infections. Results:At the end of 2018, the total number of HIV infections was estimated 35 977 with the rate of diagnosis as 77.50 % in Honghe prefecture of Yunnan province. The number of new HIV infections appeared as 23 792 in 2008-2018. Cumulatively, the number of new HIV infections was 12 185 up to 2007. The estimated number of new HIV infections decreased from 2 602 in 2008 to 1 480 in 2018. The weight of diagnostic delay decreased from 5.49 in one year to 1.00 in 20 years, and the diagnosis rate increased from 18.2 % to 100.0 % during 20 years. Conclusion:In Honghe prefecture of Yunnan province, the number of newly infection showed a declining trend but the diagnostic rate was still far from reaching the "first 90 % target" . It is expected to expand the timeliness on detection and case-finding so as to reduce the risk of HIV transmission.