Objective The study aimed to observe the clinical effects and the adverse reactions of recombinant mutant human tumor necrosis factor-alpha ( rhu-TNF) on the treatment of malignant pleural effusion ( MPE) induced by lung adenocarcinoma . Methods 70 patients with MPE caused by lung adenocarcinoma hospitalized in our department were chosen as the research objects . After conventional drainage of pleural effusion , the patients were divided into two groups according to the weight , respectively receiving intra pleural injection of 2 000 000 units and 3 000 000 units of rhu-TNF, followed by the observation of clinical effects and adverse reac-tions.A further retrospective analysis were made on the effects of dexamethasone injected before operation on clinical effects and ad -verse events. Results The effective rates of 2 000 000 unit group and 3 000 000 unit group were respectively 75.68%and 87.88%(P=0.23), with no statistical difference.The adverse reactions in the group of patients being injected dexamethasone before operation significantly reduced(P=0.021) and the use of dexamethasone had no influence on the efficacy of rhu-TNF ( P=0 .486 ) . Conclusion Rhu-TNF is a safe drug with high efficiency in the treatment of MPE induced by lung adenocarcinoma , and the efficacy and safety of re-peated application in clinic still need more supporting data .

Objective To analyze the epidemic characteristics and influencing factors of influenza outbreaks in Xinwu District of Wuxi City from 2017 to 2019, and to provide a basis for the prevention and control of influenza outbreaks in schools. Methods The 2017-2019 influenza data was retrieved from the China Influenza Surveillance Information System and the Public Health Emergency Management System. A descriptive epidemiology method was used to analyze the characteristics of the influenza outbreaks. The related factors on the epidemic intensity and duration were analyzed. Results From 2017 to 2019, a total of 26 influenza outbreaks occurred in Xinwu District, with a cumulative total of 927 cases and an average prevalence rate of 1.74%. The outbreaks mainly occurred between November and April of the following year, accounting for 100%. The outbreaks all occurred in schools, with primary schools accounting for 88.46% (23/26) and kindergartens accounting for 11.54% (3/26) of the total. The main influenza viruses that caused influenza outbreaks were B/Victoria and B/Yamagata, which accounted for 65.60% (164/250) and 16.40% (41/250), respectively, followed by influenza A/H3N2, which accounted for 16% (40/250). The epidemic intensity was related to the number of students (P < 0.05), and the duration of the epidemic was related to the type of schools and the reporting time of the epidemic (P < 0.05). Conclusion The outbreaks of influenza had obvious seasonality, and occurred mainly in schools. Improving the timeliness of epidemic reporting and taking timely control measures are the key to controlling influenza outbreaks in schools.

Animal operation training is an important course that medical students need to study before they get into their clinical practice.Because there is no cavity mirror operation training standard and teaching experience for interns,we have put forward and conducted the animal laparoscopic teaching applications in surgery teaching,and evaluated the teaching effect.Through training,the clinical medical students have personally experienced and learnt basic operation skills of laparoscopic surgery,which is an organic link from textbooks to clinical practice,and at the same time they have improved the ability of clinical practice,cultivate and strengthen their interest in laparoscopic surgical skills training and operation,which help them lay a good foundation for clinical practice.

Objective To assess the technical feasibility, patency and outcomes of subintimal angioplasty (SIA) for treatment of the lower extremity arteriosclerosis occlusions. Methods During the period from December 2003 to August 2008, 122 lower extremities with arteriosclerosis occlusions (median length, 10.25 cm;range, 4.5 to 28 cm) were treated on an intention-to-cure basis with SIA. Twenty-three lower extremities had disabling claudication and ninety-nine had limb-threatening ischemia. Patient history, demographics, procedural details, complications, and follow-up information were collected and analyzed. Patency, limb salvage, sustained improvement in claudication was determined by Kaplan-Meier analysis. Results The technical success rate of SIA was 83%. Following successful SIA, the mean ankle-brachial index increased from 0.19±0.11 to 0.67±0.29 (P<0.01). Primary patency at 12 and 24 months was 54%±5% and 45%±4% respectively, the clinical effective rates (rates of limb salvage and improvement in claudication) at 12 and 24 months were 82%±5% and 79%±4% respectively. No serious complications occurred. Conclusion In a selected group of patients, SIA is feasible with a high technical success rate and the clinical effective rates are satisfactory, there were no severe complications. SIA is a good treatment alternative in patients suffering from chronic ischemia with arteriosclerosis occlusions in the lower extremity.

Purpose: To apply staged arteriovenous reversal in the treatment of extensive and diffuse arterial occlusive disease of the limb. To avoid amputation of the limb or to limit it to necrosed segments.
Methods: Exactly 138 patients (a total of 153 severely ischemic limbs) were applied staged arteriovenous reversal (AVR) from January 1984 to December 1995. Generic-specific involvement totaled 106 men and 32 women. Their ages ranged from 24 to 71, averaging 48.7 years. The duration of symptoms ranged from 15 days to 17 years. A total of 112 patients were diagnosed as having Buerger's disease, and 25 had arteriosclerosis. In one patient, the popliteal artery was completely obstructed by acute emboli of atheromatous plaques. Three patients with Buerger's disease had not benefited from lumbar sympathectomy or partial adrenalectomy done several years ago. According to different levels of extensive and diffuse arterial occlusion, arteriovenous reversal was formed at three different sites: (1) high-deep reversal, produced between the external iliac, common femoral, or superficial femoral artery and the superficial femoral vein; (2) low-deep reversal between the distal popliteal artery and tibioperoneal venous trunk; (3) superficial reversal, established between the distal popliteal artery and distal portion of the long saphenous vein.
Results: Until June 1996, a total of 132 patients were followed up for 0.5-12 years, averaging 6.5 years. The postoperative results of all limbs except 12 in this series are excellent or good. Cardiac dysfunction does not occur, nor does the marked elevation of venous pressure of the limb.
Conclusion: We consider that if the deep venous trunks are patent, the limbs with extensive arterial occlusion are indicated for staged AVR if severe ischemia is present and all other therapeutic methods have failed. Even with necrotic limbs, this operation may lower the level of amputation. The authors suggest that staged arteriovenous reversal is a new and effective approach in the treatment of extensive arterial occlusive disease of the limb.

Objective The purpose of this study was to assess the technical feasibility, safety and effectiveness of percutaneous transluminal angioplasty (PTA)for the treatment of severe limb ischemia caused by tibioperoneal arteries occlusion. Methods From June 2004 to May 2007,35 patients with critical limb ischemia (CLI)were treated on an intention-to-treat basis with tibioperoneal arterial PTA. Main outcome measures were technical success rate, primary patency rate, limb salvage rate and complications. Results The technical success rate of tibioperoneal arterial PTA Was 83%.Mean follow-up time was 11.5 months, primary patency rate and limb salvage rate were 57%and 82%,respectively.Mean length of tibioperoneal arterial PTA was 9.5 cm(4.5～14 cm),concurrent treatment of iliac artery or femoral-popliteal artery was carried out in 19 patients via either angioplasty or combined with stenting.There were three complications including arterial spasm and thrombosis in one, which Was relieved by thrombolysis and antispasmodics, and artery perforation in 2 cases, which was treated conservatively. Conclusion In tibioperoneal arterial occlusions in CLI patients, PTA is feasible with a high initial technical success rate and high limb salrage rate,tibioperoneal arterial PTA carries a lower morbidity and less severe complications. PTA is a safe, effective and good treatment alternative for CLI patients of tibioperoneal arterial occlusions.

Objective To assess the clinical efficacy of acupuncture at the sphenopalatine ganglion for the treatment of patients with moderate to severe allergic rhinitis.Methods 42 cases of moderate to severe allergic rhinitis patients in Otorhinolaryngology clinic of Tongren Hospital between August 2012 to November 2013 were randomized into a treatment group and a control group. The treatment group was treated by acupuncturing sphenopalatine ganglion, once per week, altogether 4 times. The control group was treated by acupuncturingFengchi(GB20),Baihui(GV20),Yingxiang(GV29),Shangxing(GV23),Taiyang(EX-HN5), Quchi(LI11) andZusanli (ST36) was used in the control group, 3 times per week for 4 weeks. The changes of the Total Nasal Symptoms Score (TNSS) and the Total Non-Nasal Symptom Score (TNNSS) were evaluated before and after treatment. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was used to evaluate the quality of life.Results One week after treatment, the scores of TNSS, TNNSS and RQLQ in both groups were significantly improved than before the treatment (treatment group: 5.0[4.0, 6.0]vs. 9.0[7.0, 10.0], 1.0[1.0, 1.5]vs. 3.0[3.0, 3.0], 44.0[35.5, 50.0]vs. 60.0[53.5,75.0]; control group: 6.0[5.5, 8.0]vs. 10.0[8.5, 10.1], 2.0[2.0, 3.0]vs. 3.00[3.0, 3.0], 50.0[45.5, 58.0]vs.43.0[27.0, 48.0]; allP<0.01); the scores of TNSS, TNNSS and RQLQ 1 week after treatment in the treatment group were significantly improved than those in the control group. The scores of TNSS(2.0[1.0, 3.0]vs. 3.0[2.0, 4.5]), TNNSS(1.0[0.0, 1.0]vs.2.0[2.0, 3.0]) and RQLQ(24.0[19.0, 29.0]vs. 43.0[27.0, 48.5])4 week after treatment in the treatment group were significantly improved than those in the control group(allP<0.01).Conclusions Acupuncture at the sphenopalatine ganglion could relieve the symptoms and improve the quality of life in patients with moderate to severe allergic rhinitis, and show more rapid and persistent therapeutic effect. It may be superior to the common acupuncture.

Objective To select omeprazole content changes smaller with dispensing method and to seek for rationality of off-label uses.Methods To measure content change of omeprazole sodium for injection mixed by different subscriptions at different time through HPLC, and compared effect of different dispensing methods on content of omeprazole sodium for injection.Results 10 mL 0.9%sodium chloride injection was chosed as dissolvent,the change of omeprazole sodium for injection content would be minor, and stability of drug solution was superior.Conclusion Dispensing methods of drug impact on its'security and validity, which is part of discuss category about medicine rational use as well.Off-label uses could not vest in unreasonable use, which should contingent on specific document,data and actual environment of medical treatment.

Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period (from December 2003 to January 2008 ), 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty (PTA).Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%,87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass (P ＜0. 01 ), but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference (P ＞ 0. 05 ). Conclusion Endovascular treatment (PTA) in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.