Objective To discuss the application value of radiofrequency ablation in combination with ozone technique in the treatment of lumbar disc prolapse.Methods 150 patients with lumbar disc prolapse were divided into observation group and control group according to the digital table,75 cases in each group.The control group was given radiofrequency ablation treatment,the observation was given radiofrequency ablation in combination with ozone injection treatment.The treatment effect of the two groups was compared.Results The total effective rate of the treatment group was 94.67%,which of the control group was 82.67%,the difference between the two groups was statistically significant (x2=5.374,P<0.05).After treatment,the waist painful disease score,straight leg-raising test angle of the observation group were (25.06±3.56)points,(78.19±15.78)°,which of the control group were (20.13±2.29) points,(60.38±11.86)°,the differences between the two groups were statistically significant (t=10.086,7.813,all P<0.05).Conclusion Radiofrequency ablation combined with ozone technique in the treatment of patients with lumbar disc prolapse can improve the clinical curative effect,and improve the patients' clinical signs,it is worthy of popularizing in clinical application.

Objective To evaluate surgical resection combined with RFA and TACE for multiple hepatocellular carcinoma.Methods Between 2010 and 2013, 27 multiple hepatocellular carcinoma cases were treated with surgical resection combined with RFA and TACE.The clinical data and postoperative complications were observed.Results Left lateral lobectomy was performed in 4 patients, left hemihepatectomy was performed in 8 patients, right liver resection was performed in 3 patients, irregular right liver resection was performed in 12 patients.The operation time was (223 ± 77) min, The intraoperative bleeding was (435 ± 144) ml.There were not postoperative severe complications, such as hepatic hematoma, liver abscess, intraabdominal hemorrhage, liver failure.Unresected focus uderwent complete necrosis or liquefaction in the RFA regions as shown by CT scanning after 1 month in 24 patients.Postoperative, TACE was performed regularly in all the patients.Lipiodol deposition on the margin of RFA regions was found in 3 patients.After a year, new foci were found in 9 cases.Patients were followed-up from 8-39 months.The median survival time after operation was 26.3 months.The survival rates were 92％, 60％, 15％, respectively after 1, 2, 3 year.Conclusions For patients with multiple hepatocellular carcinoma, surgical resection combined with RFA and TACE was safe and effective.

Objective To investigate the regulation of CCL22/CCR4 signaling on CD4 + CD25 + regulatory T cells (Tregs) and immune escape in hepatocellular carcinoma (HCC).Methods CCL22,interleukin-2 (IL-2),transforming growth factor-β (TGF-β),and interleukin-10 (IL-10) levels in tumor tissue of 30 HCC patients were determined by ELISA.Tumor infiltrating lymphocytes were isolated and assayed by flow cytometry to evaluate the change of CD4 + CD25 + Tregs in tumor tissue,and CCR4 in CD4 + CD25 +Tregs were detected.Results The CCL22 level in tumor tissue was obviously increased.The level of CCL22 in tumor tissue was (920.1-± 180.1)ng/L,which was significantly higher than that in non-tumor tissue [(227.2 ± 108.6) ng/L; P ＜ 0.05].The tumor infiltrating CD4 + CD25 + Tregs was obviously increased,reaching approximately to (13.3 ±4.0)％,and the CCR4 expression in CD4+ CD25 + Tregs increased to (8.8 ± 3.0) ％.Along with progression in clinical TNM staging,the levels of CD4 + CD25 + Tregs and CD4 + CD25 + CCR4 + Tregs in tumor tissue increased,and were correlated with the CCL22 level.IL-2 level in tumor tissue was decreased,but TGF-β and IL-10 levels were increased.HCC tissue can secrete a large amount of CCL22 that could recruit CD4 + CD25 + Tregs to tumor tissue by activating CCL22/CCR4 signaling.CD4 + CD25 + Tregs played an important role in the immune escape of HCC by releasing plenty of TGF-β and IL-10 and inhibiting IL-2 secretion.Conclusion This study validates CCL22/CCR4 as therapeutic targets in immunotherapy for HCC.

Objective To explore the clinical efficacy of locking plate in the treatment of postoperative nonunion of limb long bone fracture.Methods We treated 53 patients whose limb long bone fracture failed to unite after operation with locking plate between April 2011 and November 2014.They were 38 men and 15 women,aged from 20 to 69 (average,39.7).There were 18 humeral fractures,5 radioulnar ones,9 femoral ones,and 21 tibial ones.On average,each patient had undergone 1.2 previous operations (from 1 to 2 times),including plating in 29 cases,intramedullary nailing in 15,and external fixation in 9.In the 15 patients whose intramedullary nails were reserved because of slightly loosening only under axial stress,lateral force and rotation,the nonunion was treated with bone autograft + unicortical or full-thickness locking plate.In the other 38 patients whose original implants were removed,the nonunion was treated by re-reaming of the medullary cavity + bone autograft + locking plate internal fixation.Regular radiological follow-ups were conducted for the patients.The functional recovery of upper limbs was evaluated by the Neer system while that of the lower limbs by the Johner-Wruhs system.Results One patient was lost to the follow-up.The rest 52 were followed up for 4 to 15 months (average,12.7 months).Nonunion was found in 2 patients whose internal fixation was broken and loosened.Bone healing was achieved in 50 cases after 4 to 6 months(average,5 months).Removal of implants was conducted in 36 patients at 12 to 24 months after operation (average,13.3 months).At the final follow-ups,the Neer score of upper limb was excellent in 15 cases,good in 5,fair in one and poor in one,giving an excellent to good rate of 90.9％;the Johner-Wruhs score of lower limb was excellent in 24 cases,good in 3,fair in 2 and poor in one,giving an excellent to good rate of 90.0％.Conclusion Locking plate can have good curative efficacy in the treatment of postoperative nonunion of long bone fracture.

Objective To explore the diagnostic value of post processing techniques of MSCT for diagnosing congenital heart disease associated with tracheobronchial stenosis in children. Methods Thirty four patients with congenital heart disease complicated by tracheobronchial stenosis were evaluated with MSCT. MPR, CPR, MinIP and VR were performed to show the tracheobronchial morphology. Findings in 43 segments of 32 cases were compared with the findings of surgical operation. Mann-Whitney test was employed to assess the significance of measurement between the post processing techniques and the operation. Results The lenghth of stenotic segments were variable seen at operation, with values between 4-39 mm in trachea, 4-33 mm in main bronchi and 3-12 mm in lobe bronchi, respectively. The biggest difference between the measurement of operation and MSCT was 4 mm (3 segments). Other differences ofstenotic segments were within 3 mm. Six segments exhibitee mild, 16 moderate and 21 severe stenosis at surgery. By contrast, five segments exhibited mild, 17 moderate and 21 severe stenosis by MPR or CPR,2 mild,9 moderate and 32 severe stenosis by MinIP and 4 mild, 11 moderate and 28 sever stenosis by VR,respectively. There was no significant difference in measuring the degree of tracheobronchial stenosis between MPR or CPR, VR and the surgery (Z =-0. 105,- 1. 479;P ＞0.05), while MinIP frequently overrated the degree of stenosis compared with the measurement at surgery (Z=-2.484,P =0. 013). Conclusion The integrated three dimensional reformations of MSCT scan can accurately evaluate the degree and extent of congenital heart disease associated with tracheobronchial stenosis in children and provide valuable information for clinical management.

Objective To investigate the surgical procedures for chronic pancreatitis associated with pancreatic duct stones.Methods The clinical data of 17 cases of chronic pancreatitis with pancreatic duct stones surgically treated were analyzed retrospectively.Results Of the 17 cases,13 had pancreatic duct stones in the head of the pancreas.4 had pancreaticolithiasis in the body and tail of the pancreas,six had additional choledocholithiasis.Surgical treatments included Roux-en-Y anastomosis of the pancreatic duct and jejunum in 6 cases(Partington procedure),anastomosis of pancreatic duct and stomach in 4 cases (Warren procedure).subtotal resection of the head of the pancreas with duodenal preservation in 3 cases (Beger's procedure).removal of the tail of pancreas with Roux-en-Y anastomosis of the distal pancreatic end to the iejunum in 3 cases(Duval's procedure),removal of the tail of pancreas and spleen with a Roux-en-Y anastomosis of the distal pancreatic end to ieiunum in 1 case.All 17 patients were cured,with complete relief of intractable abdominal pain in 15 cases.blood glucose was under eontrol in two out of six diabetics.Two cases suffered from postoperative pancreatic fistula.one patient died of pancreatic cancer 11 months after operation.Conclusion For patients with chronic pancreatitis and pancreaticolithiasis.surgical treatment should be highly individualized.We suggest drainage procedures for patients with dilatation of the pancreatic duct.Patients with no dilatation of the pancreatic duct and those with suspected carcinoma can be treated by partial pancreatectomy and Roux-en-Y pancreaticojejunostomy.Meanwhile effort must be applied to preserve the exocnne and endocrine pancreatic function vital for the patient's quality of life.

Objective To investigate the clinical manifestation,therapeutic methods and treatmenteffectiveness of hand contracture due to extravasation injury from peripheral intravenous therapy in children.Methods Data of 6 children who had received treatment for hand contracture in our hospital from March 2004 to September 2011 were retrospectively analyzed.There were 3 boys and 3 girls,aged from 24 to 51 months (average,38 months).Two children underwent extensor tenolysis and dorsal capsular release at the metacarpophalangeal (MCP) joints.The other 4 children received conservative treatment,including physical therapy (ultrasound and medium frequency pulse) to reduce the hand swelling and peritendinous adhesion,active and passive functional exercise of digital joints and night splint protection.Results The MCP joint could be passively flexed to 90° intraoperatively in 2 children who underwent operation; however the contracture recurred at 2 months and 6 months after operation,respectively,and then the MCP joints were fixed at 0° position.For 4 children who received conservative treatment,although the active flexion of their MCP joints ranged from 30° to 45° during the rehabilitative procedure,recurrence of hand contracture was observed after the cessation of the rehabilitation in all children,and the range of active MCP joints flexion varied from 0° to 15°.Conclusion The mechanism underlying hand contracture due to extravasation injury from peripheral intravenous therapy remains elusive.Either simple conservative or surgical management results in poor functional outcomes.Combined therapy based on different indications for conservative and surgical management may improve the outcomes.

Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP).Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed.Results Prior to renal transplantation, the platelet count of these two patients was 41 ×109 /L and 34 ×109 /L,respectively.The coagulation function was normal and no active bleeding was observed.They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively.The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation.Though receiving platelet-promoting drugs and platelet infusion,the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10 ×109 /L and 30 ×109 /L after renal transplantation.Renal function was well maintained in both recipients.Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not.Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.

Objective To summarize the clinical characteristics and treatment experience on vascular complications of transplant renal artery.Methods Of 322 patients undergoing renal transplantation in the 281st Hospital of People's Liberation Army from June 2007 to June 2014,29 patients developed vascular complications of transplant renal artery after transplantation. Clinical data of such 29 patients were retrospectively studied to summarize the clinical characteristics and treatment experience.Results Two patients developed anastomotic haemorrhage of transplant renal artery,23 patients developed transplant intrarenal artery spasm,2 patients developed transplant renal artery thrombosis and 2 patients developed transplant renal artery stenosis.The anastomotic haemorrhage from transplant renal artery was postoperative haemorrhage,and surgical exploration and hemostasis were conducted in time. Patients with transplant intrarenal artery spasm were given antispasmodic treatment during operation.And the dark red and soft renal graft became full and ruddy.Patients with transplant renal artery thrombosis underwent surgical exploration once confirmed.The renal grafts were dark red and did not recover to normal after blood supply recovery,thus the renal grafts were removed.For patients with developed transplant renal artery stenosis,balloon dilatation and stent implantation were adopted.The blood pressure of patients returned to normal and the renal function was normal.Conclusions Vascular complications of transplant renal artery are characterized by quick progression, fast condition changes and serious consequences.In order to reduce the incidence and increase the recovery rate,active prevention and decisive treatment are very important.