This study was aimed to investigate the clinical effect of tetramethylpyrazine in combination with ipratropium bromide in the treatment of bronchial asthma and its effects on inflammatory factors and leptin. According to inclusion criteria, a total of 124 bronchial asthma cases were included and randomly divided into two groups, which were the control group (n = 62) and the observation group (n = 62) with the random number table. Besides conventional treatments, the control group was given ipratropium bromide; while the observation group was given tetramethylpyrazine in combination with ipratropium bromide. Then, comparisons were made between two groups on the therapeutic efficacy rate, pulmonary function, inflammatory factor, leptin, and incidence of adverse reactions. The results showed that the total therapeutic efficacy rate was 96.8% in the observation group, which was obviously higher than that of 87.1% in the control group (P < 0.05). In comparison with the control group, the posttreatment pulmonary function indexes PEF and FEV1/FVC increased, inflammatory factors IL-6 and IL-4 decreased, and IL-12 increased in the observation group with statistical significance (P < 0.05). One week, 2 weeks and 4 weeks after the treatment, the level of leptin in the observation group was significantly lower than that in the control group (P < 0.05). During the treatment, there were no severe adverse reactions. The incidence of adverse reactions in the observation group was 11.3%, which was statistically the same with that of 14.5% in the control group (P > 0.05). It was concluded that tetramethylpyrazine in combination with ipratropium bromide was effective for bronchial asthma treatment, which can significantly increase curative efficacy, improve pulmonary function, alleviate inflammatory reaction and reduce leptin level with minor adverse reactions. It required further studies in the clinical practice.

Objective To investigate the effective MRI sequences and describe the correlation between MRI and visual evoked potential(VEP)in diagnosing optic neuritis.Methods One hundred and fifty-four eyes with visual impairment of 98 patients with diagnoses of optic neuritis,papillitis,multiple sclerosis and Devic's disease underwent MRI and VEP examination. The MRI findings were analyzed and correlated with VEP results and clinical presentation by using x2 test,wilcoxon test and Kappa test.Results Out of the 154 sick eyes.56 eyes presented thickened optic nerves.76 eyes had normal diameter of the optic nerve,and 22 eyes had thin optic nerves.A total of 132 optic nerves showed abnormally high signal in STIR sequences.including involvement of intraocular segment in 7,intraorbitsl segment in 135,intracanalicular segment in 109,intracranial segment in 97,optic chiasm in 56,and optic tract in 23.A total of 54 patients underwent postcontrast MRI. Seventy-four optic nerves of 87 eyes showed enhancement.Among the 196 eyes of 98 patients,132 eyes presented visual impairment and simultaneous abnormal MR signal of the optic nerve.and 26 eyes had both normal vision and normal MR signal of optic nerve.The consistency of MRI findings and vision status was 80.61%(Kappa=0.453,P＜0.01).Among the 175 eyes with VEP results.129 eyes had visual loss with simultaneous VEP abnormalities,and 30 eyes had both normal vision and normal VEP results.The consistency of VEP and vision status was 90.86%(Kappa=0.731,P＜0.01).Among the 175 eyes with VEP results,117 eyes had abnormal MR signal of the optic nerve and simultaneous abnormal VEP,and 24 eyes had both normal MR signal of the optic nerve and normal VEP.The consistency of MRI findings and VEP was 80.57%(Kappa=0.460,P＜0.01).Conclusion STIR sequence and gadolinium-enhanced T1-weighted MR sequence combined with fatsuppression are helpful in diagnosis of optic neuritis.VEP is helpful in diagnosing optic neuritis and in finding subclinical visual problem.The MRI combined with VEP could improve the diagnostic accuracy of optic neuritis.

Objective To evaluate the role of chemokine CXCL12 in the spinal cord in the development of bone cancer pain (BCP) in rats and the relationship with microglial activation.Methods Thirty-two female Sprague-Dawley rats,weighing 180-220 g,were equally randomized into 4 groups (n =8 each) using a random number table:sham operation group (group S),BCP group (group B),BCP + CXCL12 neutralizing antibody group (group BC),and BCP + IgG control antibody group (group BI).BCP was induced by injecting Walker 256 mammary gland cancer cell suspension (4 × 105 cells/ml) 5 μl into the bone marrow of the right tibia of rats anesthetized with chloral hydrate in B,BC and BI groups,while the equal volume of normal saline was injected instead in group S.On 12,13 and 14 days after injection of mammary gland cancer cells,CXCL12 neutralizing antibody 10 μg/15 μl was intrathecally injected once a day in group BC,while IgG control antibody 10 μg/15 μl was intrathecally injected once a day in group BI.Before injection of mammary gland cancer cells (T0) and on 3,5,7,10,12 and 14 days after injection of mammary gland cancer cells (T16),paw withdrawal threshold to mechanical stimulation (PWMT) was measured.The rats were then sacrificed and L4,5 segments of the spinal cord were removed for determination of Iba-1 (pan-microglial marker) expression in spinal dorsal horn using immunofluorescence after PWMT measurement at T6.Results Compared with S group,PMWT was significantly decreased at T2-6,and Iba-1 expression was up-regulated at T6 in B,BC and BI groups (P ＜ 0.01).Compared with B group,PMWT was significantly increased at T5,6 and Iba-1 expression was down-regulated at T6 in BC group (P ＜ 0.01).Conclusion Chemokine CXCL12 in the spinal cord is involved in the development of BCP,and microglial activation is involved in the mechanism.

Objective To investigate the treatment of open vertebreplasty for unstabilized thoracic-lumbar fracture. Methods From September 2003 to May 2007, there were 31 patients of thoracic-lumbar burst fracture who had undergone operation and had been followed. According to the Denis classification, all the patient were burst fracture with the involvement of middle column. All of them were undergone posterior short segment transforminal interbody fusion and vertebreplasty filled with phosphate calcium bone cement. Results All of 31 patients had undergone operation successfully. The interbody were removed when fracture healed. There was no loss of vertebral height, no degenerative change of adjacent segment. They were followed for 9～35 months, the average was 24.2 month. 2 of 31(6.4%) were found collapse of the fracture vertebrae, 1 was found kyphosis and failure fusion, which led another operation. The reason may be the severe burst of vertebrae, insufficient filling of phosphate calcium bone cement or bearing weight early stage. Of all other patients, CT scan showed sufficient decompression of fracture vertebraes, retained height of fracture vertebraes and no collapse. There was no obvious difference between height of fracture vertebrae and normal vertebrae (P0.05). The loss of correction of kyphosis was not obvious. Conclusion posterior short segment transforminal interbody fusion and vertebreplasty filled with phosphate calcium bone cement is a effective treatment for unstabilized thoracic-lumbar fracture. The pain is relieved after operation, patient can exercise on the ground in the early stage, and the quality of life is improved.

A patient with intermittent right lumbar pain for more than one month and aggravating for one week was reported. The right laparoscopic radical nephrectomy was performed, and fibrosarcoma of the right kidney was diagnosed. The patient refused further radiotherapy or chemotherapy and was discharged on the 11th after surgery. One year after operation, the patient underwent chest CT, and subdural tumor of right lobe of liver was detected. A surgery was performed in another hospital, and liver metastasis from right renal fibrosarcoma was diagnosed. He was alive four months after operation.

Objective:To evaluate the efficacy of arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique for the treatment of tibial avulsion fracture of posterior cruciate ligament (PCL).Methods:A retrospective case series study was conducted to analyze the clinical data of 32 patients with tibial avulsion fracture of PCL, who were admitted to First People′s Hospital of Huizhou from January 2018 to October 2022. There were 19 males and 13 females, with age range of 18-65 years [(42.8±15.0)years]. By the Meyers-Mckeever classicfication, 27 patients were type II, and 5 type III. All the patients were treated with arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique to fix PCL tibial avulsion fracture at the insertion point. The fracture reduction was observed by X-ray films before discharge. Three months postoperatively, the fracture healing was observed by CT imaging, and the stability of knee joint was evaluated by posterior drawer test. The knee active range of motion, visual analogue score (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) score were used to evaluate the pain and knee function before operation, at 3 months after operation, and at the last follow-up. Intraoperative and postoperative complications were observed.Results:All the patients were followed up for 6-36 months [(19.7±8.7)months]. The X-ray films showed satisfactory reduction of the fracture before discharge, and the CT showed that the fracture line was blurred to various degrees at 3 months after operation. Two patients had degree I positive posterior drawer test at 3 months after operation, and the rest were negative. The knee active range of motion was improved from 54.2°(45.0°, 70.0°) preoperatively to 124.8°(120.0°, 130.0°) at 3 months postoperatively and to 130.6°(125.0°, 135.0°) at the last follow-up (all P<0.01). The VAS was decreased from 5.1(3.0, 7.0)points preoperatively to 1.2(1.0, 2.0)points at 3 months postoperatively and to 0.1(0.0, 0.0)points at the last follow-up (all P<0.01). The Lysholm score was improved from 31.2(24.3, 37.0)points preoperatively to 73.6(69.3, 78.8)points at 3 months postoperatively and 92.6(91.0, 95.0)points at the last follow-up (all P<0.01). The IKDC score was increased from (20.9±7.1)points preoperatively to (59.2±8.9)points at 3 months postoperatively and to (77.5±7.0)points at the last follow-up (all P<0.01). Compared with 3 months after operation, the last follow-up showed significantly improved knee active range of motion, significantly decreased VAS, and significantly increased Lysholm score and IKDC score (all P<0.05). No intraoperative nerve vascular injury, postoperative incision infection, or lower limb venous thrombosis was observed. Conclusion:Arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique can achieve good reduction and high healing rate in patients with tibial avulsion fracture of PCL, with improved joint mobility, relieved pain, good recovery of knee joint function, and few complications.

Objective:To evaluate the efficacy and safety of endoscopic stricturotomy (EST) under balloon-assisted enteroscopy (BAE) in treatment of benign jejuno-ileal stenosis.Methods:From December 2015 to August 2021, at the Air Force Medical Center, 41 patients who were diagnosed with benign jejuno-ileal stenosis underwent BAE deep small bowel EST and/or surgery due to ineffective or ineffective drug treatment were retrospectively analyzed. Twenty-one patients were treated with EST (EST group) and 20 patients were treated with surgery (surgery group). The etiology and follow-up time were analyzed, the general conditions (male proportion and age), the immediate technical success rate (the percentage of the stenosis that the enteroscope could pass through after EST in the total number of treated stenoses), the incidence of complications (including perforation, bleeding, etc.), the symptom remission rates at 3-month, 6-month, and 1-year after treatment (the percentage of patients with complete or partial remission in the total number of patients), cumulative symptom-free survival rate (no obstruction-related symptoms after EST or surgery till the last follow-up) and cumulative surgery-free survival rate of two groups were compared. Chi-square test, independent t-test, Fisher′s exact probability method and Kaplan-Meier analysis were used for statistical analysis. Results:The main etiology of stricture of EST group and surgery group was Crohn′s disease (71.4%, 15/21 and 60.0%, 12/20, respectively), and the median follow-up time was 12 months (6 to 46 months) and 45 months (14 to 73 months), respectively. There were no significant differences in male proportion, age, immediate technical success rate and incidence of complication between EST group and surgery group (57.1%, 12/21 vs. 65.0%, 13/20; (45.2±17.4) years old vs. (43.1±20.3) years old; 95.3%, 41/43 vs. 100.0%, 30/30; 26.9%, 7/26 vs. 10.0%, 2/20, all P>0.05). In the EST group, 9.5% (2/21) of the patients received surgery because of perforation during EST, 76.2% (16/21) of the patients did not need surgery after EST, and the median symptom-free survival time of patients without symptoms in EST group was 13.3 months. There was no significant difference in the symptom remission rate at 3-month after treatment between EST group and the surgery group (17/19 vs. 100.0%, 20/20, P>0.05). The symptom remission rate at 6-month and 1-year of EST group were lower than those of the surgery group (15/19 vs. 100.0%, 20/20; 8/11 vs. 100.0%, 20/20), and the differences were statistically significant (both were Fisher′s exact probability method, P=0.047 and 0.037). The cumulative symptom-free survival rates at 3-month, 6-month and 1-year of EST group and surgery group were 66.0% vs. 90.0%, 61.0% vs. 85.0% and 54.0% vs. 80.0%, respectively.The results of Kaplan-Meier analysis indicated that there was no significant difference in the symptom-free survival curve between two groups ( P>0.05). The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in EST group were 90.0%, 81.0% and 73.0%, respectively. The 3-month, 6-month and 1-year cumulative surgery-free survival rates after treatment in surgery group were all 100.0%. Conclusion:EST under BAE is technically feasible, and safe in the treatment of benign jejuno-ileal stenosis, and can effectively relieve clinical obstruction symptoms and avoid or delay surgery in the short term.

A female patient who was admitted to the hospital on March 4, 2020 due to the right kidney mass for 4 days by physical examination. Ultrasound examination revealed a single space-occupying lesion in the right kidney, and further examination of the abdominal enhanced CT and three-dimensional reconstruction showed two lesions in the right kidney. The retroperitoneal laparoscopic partial nephrectomy was carried out. The pathological diagnosis were renal leiomyoma and renal eosinophiloma, respectively. After 1 year follow-up, no recurrence or metastasis was found.

The segmental testicular infarction rate is extremely low, usually showing acute testicular pain, which needs to be distinguished from testicular tumor, testicular torsion, etc. Only a few cases were reported. In this study, two cases were presented. Case one, a 13-year-old boy, was admitted to hospital due to right testicular swelling and pain for 3 days. Presenting with vomiting once on May 5, 2017.He underwent right scrotum exploration and testicular fixation. Testicular pain was disappeared and discharged on the five days operation. There was no obvious abnormality in color doppler ultrasound after one year after operation. Another patient, a 26-year-old man, was admitted to hospital due to left testicular swelling and pain for 6 on March 15, 2018. He was treated with Xue Saitong, natra heparin calcium and Maizhiling tablets. After seven days of treatment, the testicular pain improved and were discharged. One month after discharge, the patient had no pain or discomfort, and the color Doppler ultrasound showed that the left subtesticular polar-like low-isoecho, and a small amount of star-like blood flow signal around.