Objective To determine the changes of coagulation indexes of rabbits struck at different levels and sieve the traditional coagulation indexes, such as activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB). Methods We used correlation analysis to precondition the data to reject indexes, and used stepwise discriminatory analysis to choose indexes and made the diagnosis by multiple linear discrimination analysis. Then, by random sampling we compared the correct diagnostic rate by 4 indexes with that by 3 indexes. Results The correct discrimination rate of blood coagulation function diagnosis in rabbits was up to 87.60% by the four indexes and 96.12% with the three indexes (APTT, PT and TT). The average correct discrimination rate of blood coagulation function diagnosis in 1 000-time random sampling was up to 83.07% by the four indexes and 85.16% by the three indexes. Conclusion Stepwise discriminatory analysis can be used to discriminate hemorrhage from thromboxane. The correct diagnostic rate gets higher when FIB was rejected.

Objective To optimize the condition of converting murine naive CD4+ CD25-T cells ( effector T cells,Teffs) to CD4-CD8-double negative regulatory T cells ( DN Tregs) in vitro.Methods Naive Teffs from C57BL/6 mouse were isolated with magnetic activated cell sorting( MACS)and co-cultured with DBA/2 mature dendritic cells (mDCs) with different doses of recombinant murine interleukin-2 (IL-2).The percentage of converted DN Tregs was examined by flow cytometry after 6 days.Purified DN Tregs were co-cultured with CFSE labeled Teffs.The proliferation rate of Teffs were evaluated by flow cytometry.Results Without IL-2,the percentage of CD4-CD8-T cells was 6.21％ ± 2.03％.With IL-2,the percentage was 14.77％ ± 2.15％ ( 25 ng/ml),21.29％ ± 2.68％ (50 ng/ml),43.45％ ±4.45％ (75 ng/ml),and 28.59％ ±3.05％ ( 100 ng/ml) respectively.The IL-2 concentration of 75 ng/ml signilicantly enhanced the conversion of Teffs to DN Tregs ( separately t =10.700,8.288,6.158,3.932,all P ＜ 0.05).Highly purified DN Trega significantly suppress the proliferation of Teffs in vitro.Conclusions Teffs are converted to DN Trega in vitro with the LPS-activated allogeneic mDCs and that 75 ng/ml of IL-2 is the optimal concentration for the conversion of Teffs to DN Trogs in vitro.

Objective To study the clinical rescue for basicranial fracture complicated with massive hemorrhage.Methods The therapies for 20 patients of basicranial fracture complicated with massive hemorrhage treated in our hospital within 3 years were analyzed retrospectively.Results Among 20 patients,16 cases were male,4 cases were female.7 cases were simple anterior basicranial fracture with massive hemorrhage,1 case was the delayed massive hemorrhage in cavernous fistula caused by anterior basicranial fracture,12 cases were anterior and mid basicranial fracture complicated with massive hemorrhage.In consequence,6 cases were secondary cerebrospinal leak,8 cases recovered,8 cases died.Conclusion The basicranial fracture complicated with massive hemorrhage is a very dangerous symptom with high death rate and high disability rate.The patients should be rescued actively.

ObjectiveTo analyze the development mechanism and investigate the more effective therapeutic method of the multiple system organs failure (MSOF) after severe craniocerebral injury.MethodsThe clinical data of 21 MSOF cases after severe craniocerebral injury was analyzed retrospectively.ResultsOf all 21 cases, 2 cured, 7 mended and 12 died with death rate 57% and deformity rate 33.3%.ConclusionTo severe craniocerebral injury, comprehensive, timely and effective therapeutic method is the key to reduce the occurrence of MSOF and the rate of death and deformity.

ObjectiveTo study the effect on humoral immunity with combination of CsA and IL-2 fusion protein. MethodsForty C57/B6 mice were evenly divided into four groups,after receiving skin graft from DBA mouse.Mice in the experimental group was given CsA(30 mg/kg,ip) plus IL-2/Fc (1μg,ip) while the control group was only given CsA,each group was given HBV vaccine after skin graft surgery (2 μg,im),while blank group was only given vaccine after skin transplantation.The fourth group were left intact.Fourteen days later,the level of HBSAb,IL-4,IL-10,IFN-γ,IL-2 were measured with ELISA and IL-21and FoxP3 expression level and Tfh percentage of mixed lymphocytes detected. ResultsThe HBSAb level in experimental group is significantly higher than that in the control group and the survival time of skin graft is longer than that in the control group ( F =29.886,P =0.010 ; F =29.772,P =0.011).IL-2,IFN-γ are significantly higher than that in the control group( F =18.156,P =0.0020;F =90.042,P =0.003 ),but the Th2 cytokines such as IL-4,IL-10 are lower ( F =42.102,P =0.009 ; F =23.734,P =0.015 ).The expression level of both IL-21and FoxP3 are significantly higher than control group( F =9.784,P =0.048 ;F =27.883,P =0.012). ConclusionsCombination of CsA and IL-2 fusion protein can significantly enhance the immunogenicity of HBV vaccine and prolong graft survival time.It may be related to the higher expression level of IL-21and FoxP3.

Objective To investigate the clinical value of lymphangiography in the diagnosis and treatment of cervical chylous fistula.Methods The clinical data of 7 patients with chylous fistula at Department of Lymph Surgery,Capital Medical University Affiliated Beijing Shijitan Hospital from Jul 2010 to Aug 2015 was retrospectively analyzed.Lymphangiography was performed to investigate the site of fistula and condition of thoracic duct.Results There were 1 male and 6 female patients aging from 22 to 59 years.All patients underwent lymphangiography successfully with dynamic imaging clearly,which accurately showed the location of the leakage and the anatomy of the thoracic duct.There was compensatory branch or trunk drainage in 2 cases which underwent successful conservative treatment,the other 5 cases with leak ＞ 500 ml a day without clear compensatory branch underwent surgical treatment and were cured with no major complications.Conclusion Lymphangiography not only clearly locates the leakage and anatomical relationship of the thoracic duct,but also guides the choice of treatment and precise surgery,avoiding the secondary injury.

Objective: To investigate the imaging features and etiology of lymphatic trunk in primary facial lymphedema. Methods: 26 patients with primary facial lymphedema patients (F/M, 13/13, ages 21.8 ± 13.9 years old) were recruited from January 2015 to October 2017 in this study, with 32 sides facial lymphedema reported, including 6 right facial lymphedema, 14 left facial lymphedema, and 6 bilateral facial lymphedema. And all the patient data and imaging were retrospective analysis to summarize the MR imaging features of thoracic duct and right lymphatic duct, meanwhile compared with surgical results. Results: For all 26 patients, MR imaging result in thoracic duct manifests 32 lymphatic duct, including 20 thoracic duct and 12 right lymphatic duct. The imaging features demonstrate two typical findings: dilated(13 cases) and slim(7 cases) demonstrations. While for right lymphatic duct, the MR result included three types: dilated(6 cases), slim(4 cases) and no sign of manifestations(2 cases). In surgery, the thoracic duct in cervical segment demonstrated abnormal structures, including capsulated by fibrous tissues in peripheral area(30 sides), surrounded by internal jugular vein sheath(11 sides), external pressed by venae cervicalis transversa(5 sides) and lymphatic trunk dysplasia(2 sides). Conclusions MR thoracic duct and right lymphatic duct imaging can be used as an effective diagnostic imaging method for primary facial lymphedema, and the structural anomaly of the upper cervical catheter and the right lymphatic catheter may be one of the pathogenic factors of primary facial lymphedema.

Objective:To examine the clinical characteristics and abnormal reflux branches of primary isolated chylopericardium.Methods:Totally 43 patients with primary isolated chylopericardium at Department of Lymphatic Surgery, Affiliated Beijing Shijitan Hospital,Capital Medical University from June 2007 to January 2018 were recruited in this study. There were 21 males and 22 females, aging (23.0±15.9) years (range: 2 to 57 years). The levels of triglyceride, total cholesterol, total protein and albumin in pericardial effusion and blood were compared by paired- t test, and the characteristics of lymphatic system in direct lymphangiography and postoperative CT were analyzed. Results:Pericardial effusion was mainly milky white and monocytes, and 95.3%(41/43) were positive for Rivalta test. The level of triglyceride in pericardial effusion was significantly higher than that of blood ((9.67±5.11) mmol/L vs. (1.28±0.89) mmol/L, t=10.557, P<0.01), and the levels of total cholesterol ((2.19±0.52) mmol/L vs. (4.12±1.06) mmol/L, t=-3.732, P<0.01), total protein ((61.25±16.17) g/L vs. (68.26±8.30) g/L, t=-2.958, P=0.005) and albumin ((36.63±7.06) g/L vs. (42.32±4.73) g/L, t=-5.747, P<0.01) were significantly lower than that of blood. In the direct lymphangiography, the imaging of iliac and retroperitoneal lymphatics showed dilated or tortuous in 90.7% (39/43), the thoracoabdominal segment of thoracic duct showed dilation in 46.5% (20/43), and cervical thoracic duct imaging showed dilation in 44.2% (19/43) and stenosis in 55.8% (24/43). The image of lipiodol flowing into the vein showed obstruction at the venous angle. There were 60.5%(26/43) of the patients with lipiodol reflux through the bronchomediastinal trunk (type Ⅰ), 11.6%(5/43) with lipiodol diffusion to the pericardium through the abnormal pathway from the thoracic segment of the thoracic duct (type Ⅱ), while no communication pathway between the thoracic duct and the pericardial cavity (type Ⅲ) found in 27.9%(12/43). CT images obtained after the direct lymphangiography showed 34.9%(15/43) had abnormal distribution of lipiodol in pericardium, mediastinal lymph nodes and lung hilar lymph nodes, 46.5%(20/43) in mediastinal lymph nodes and lung hilar lymph nodes, 14.0%(6/43) only mediastinal lymph nodes, 4.6%(2/43) had no lipiodol in the above areas. Conclusions:Pericardial effusion compared with same period blood, has higher triglyceride, lower total cholesterol, total protein and albumin. The obstruction of the cervical segment of the thoracic duct and the formation of abnormal reflux branches would be corelative to primary isolated chylopericardium.

Objective:To investigate the clinical features of primary intestinal lymphangiectasia (PIL).Methods:This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of ( M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tc m-labeled human albumin ( 99Tc m-HSA) scintigraphy, 99Tc m-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results:Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tc m-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tc m-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions:The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tc m-HAS scintigraphy, 99Tc m-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.

Objective:To explore the blood loss during liposuction for secondary lymphedema of the lower extremities and to analyze the risk factors that influence the blood loss.Methods:Retrospective analysis of the clinical data of patients with secondary lymphedema of lower extremities at the Department of Lymphatic Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital from January 2019 to December 2019. The following clinical indicators were correlated with the amount of blood loss, including age, body mass, body mass index (BMI), primary disease, hypertension, radiotherapy history, chemotherapy history, erysipelas history, affected extremity, duration of swelling, duration of primary disease, International Society of Lymphology(ISL) stage, time of operation, infiltration volume, fat aspiration, blood-tinged fluid solution, volume difference, preoperative hemoglobin. Pearson analysis was used for the univariate analysis of continuous variables, Spearman analysis was used for the univariate analysis of classified variables, multiple linear regression was used for multivariate analysis of continuous variables, and Logistic regression was used for the multivariate analysis of classified variables.Results:174 patients were enrolled, all females with a median age of 55 years. Univariate analysis showed that the age( r=0.17, P=0.026), the body mass( r=0.37, P<0.001), BMI( r=0.29, P<0.001), hypertension( r=0.25, P=0.001), the ISL stage( r=0.40, P<0.001), operative time( r=0.44, P<0.001), infiltration volume( r=0.53, P<0.001), fat aspiration( r=0.36, P<0.001), blood-tinged fluid solution( r=0.61, P<0.001) and volume difference( r=0.63, P<0.001) were associated with the blood loss. There was no correlation between primary disease, radiotherapy history, chemotherapy history, erysipelas history, affected extremity, duration of swelling, duration of primary disease, preoperative hemoglobin and blood loss( P>0.05). Multivariate analysis showed that hypertension ( r=0.14, P=0.012), operative time ( r=0.15, P=0.019) and volume difference ( r=0.30, P=0.001) were independent risk factors affecting blood loss. Conclusion:Hypertension, operative time and volume difference are the risk factors of blood loss during liposuction for secondary lymphedema of the lower extremities.