Objective To study the lateral branch of thoracodorsal nerve and the deltoid branch of axillary nerve under microscope for clinical application in the reconstruction of brachial nerve injury. Methods 31 lateral branches and deltoid branches of axillary nerve on 17 cadaver specimens were studied on topography under the light microscope(? 5) to observe the length, diameter, and the number of branches. The number of fibers was counted on the HE- stained section of the nerves. Three cases were performed: In operationⅠ , the lateral branch of thoracodorsal nerve was connected with the deltoid branch of axillary nerve. In operationⅡ , on the base of the first operation, the medial branches of the thoracodorsal nerve partially the latissimus dorsi was reconstructed for recovery of the flexion function of the elbow. In operationⅢ , the latissimus dorsi was section into two parts according to the innervation of the medial and lateral branches of the thoracodorsal, and the two branches of the thoracodorsal were transplanted in a dislplaced position for the restoration of flexion function of the elbow and the fingers. Results Thoracodorsal nerves have 2 branches near dorsal aspect of the latissimus dorsi. The lateral branch is thicker with the average length of 58.2 mm avaliable for the reconstruction purpose; the diameter is in average of 1.46 mm, the number of fibers is in average of 1 519; 90.4％ of the lateral branches redivided into 2 or 3 branches. The diameter of the deltoid branch of axillary nerve is 2.31 mm in average and 61.3％ give 3 branches; 32.3％ 2 branches; the number of fibers is in average of 2 341. Clinically the reconstruction operation is successful. In operationⅠ the strength of the deltoid muscle recovered to grade 4; in operationⅡ the strength of the deltoid muscle and elbow- flexing is reached grade 4 and in operationⅢ the strength of elbow- and finger- flexion recovered to grade 4. Conclusion Reconstruction of two muscular groups of the latissimus dorsi with loss of nerve innervation is effective by the application of double branch potential of the thoracodorsal nerve.

Objective To investigate the relationship between plasm N-terminal pro-B-type natriuretic peptide(NT-proBNP) levels and severity of coronary artery disease and coronary artery lesions. Methods 150 patients complaining of chest pain and suspected to have coronary artery disease (CAD) were enrolled in the study. Plasm NT-proBNP contents were determined with ELISA method within 48h, and left ventricular ejection fraction (LVEF) was assessed with echocardiography 5-7 days after admission. All patients underwent coronary artery angiography(CAG) 2-17 days after admission and the severity of coronary artery lesions was estimated by coronary angiographic Gensini scores. According to the clinical data and results of CAG, 78 patients were diagnosed as acute coronary syndromes (ACS), 33 patients as stable angina, and 39 patients in whom angiography showed negative findings, served as normal controls. The correlation of plasm NT-proBNP levels with clinical severity of coronary artery disease and Gensini scores were analysed. Results Plasm NT-proBNP levels in patients with ACS, stable angina and in normal controlls were 526.96?376.90, 95.61?56.32 and 41.75?24.26pg/ml,respectively(P

Objective To investigate the regulatory effects of hedgehog pathway on intestinal epithelial barrier function under hypoxia.Methods The IEC-6 cells of rats were divided into 3 groups:the normoxia group (21％ oxygen concentration),the hypoxia group (2％ oxygen concentration) and the hypoxia + cyclopamine group (cells pretreated by 5 mmol/L of cyclopamine,and then exposed in an atmosphere with 2％ oxygen concentration).The mRNA expressions of IHH,PTCH and GLI-1 were detected,and the transepithelial electrical resistance (TER) was determined.The protein expressions of tight junction proteins (ZO-1,Occludin,Claudin-1) and IHH were assayed by using the Western blot.All data were analyzed using the one-way analysis of variance or LSD-t test.Results The relative mRNA expressions of IHH,PTCH and GLI-1 were 0.056 ± 0.009,0.459 ± 0.087,0.142 ± 0.023 in the normoxia group,and 0.303 ± 0.052,0.678 ± 0.073,0.483 ± 0.061 in the hypoxia group,with significant difference between the 2 groups (t =-14.05,-11.85,-6.52,P ＜ 0.05).The relative protein expressions of IHH in the normoxia group and the hypoxia group were 0.39 ±0.06 and 0.91 ±0.15,with a significant difference between the 2 groups (t =-8.08,P ＜ 0.05).The TERs of the normoxia group,the hypoxia group and the hypoxia + cyclopamine group were (134 ± 5) Ohm/cm3,(100 ± 6) Ohm/cm3 and (118 ± 5) Ohm/cm3,with significant difference between the 3 groups (F =1.04,P ＜ 0.05).Compared with the normoxia group,the TER of the hypoxia group was decreased by 27.7％ (t =7.84,P ＜ 0.05) ; compared with the hypoxia group,the TER of the hypoxia + cyclopamine group were increased by 16.4％,but it was still significantly lower than the normoxia group (t =4.23,P ＜ 0.05).The expressions of ZO-1,Occludin and Claudin-1 were 1.18 ± 0.24,0.80 ±0.13 and 0.90 ±0.09 in the normoxia group,and 0.58 ±0.08,0.32 ±0.05 and 0.50 ±0.09 in the hypoxia group,and 0.92 ± 0.21,0.43 ± 0.10 and 0.82 ± 0.11 in the hypoxia + cyclopamine group,with significant difference between the 3 groups (F =4.95,2.88,10.09,P ＜0.05).The expressions of ZO-1,Occludin and Claudin-1 in hypoxia group were decreased by 48.7％,40.0％ and 55.6％ when compared with the normoxia group (t =12.86,9.35,18.90,P ＜0.05).The expressions of ZO-1,Occludin and Claudin-1 in the hypoxia + cyclopamine group were increased by 59.9％,35.2％ and 65.1％ when compared with the hypoxia group (t =5.63,2.92,6.66,P ＜ 0.05).Conclusion Hedgehog signal pathway could be activated under hypoxia,and then the expressions of tight junction proteins are decreased,which finally induces the injury of intestinal epithelial barrier function.

Objective This study was to investigate the effect of using laryngeal mask airway (LMA)as a transition method after double lumen endotracheal anesthesia on the stress response dur-ing the extubation period.Methods Ninety patient underwent general anesthesia with double lumen endotracheal intubation were randomly divided into 3 groups:group A,B and C (n=30).Patients in group A were extubated directly after surgery.The double lumen endotracheal tube were changed to single lumen endotracheal tube under deep anesthesia in group B patients,while the double lumen en-dotracheal tube were changed to LMA in group C.MAP,HR and rate pressure product (RPP)at the end of surgery (T0 ),1 minute before extubating the endotracheal tube (laryngeal mask)(T1 ),1 mi-nutes (T2 ),5 minutes after extubating (T3 )were recorded.The reaction of extubation,such as buc-king or restlessness,was also observed.Results Compared with T0 ,the MAP,HR,and RPP were significantly increased in groups A and B at T1-T3 (P <0.05 ).Compared with group A,the MAP, HR,RPP were significantly decreased in groups B and C at T1-T3 (P <0.05 ).The number of buc-king and restlessness in group C were lower than that in group A and group B (P < 0.05 ). Conclusion The use of laryngeal mask during the transition period in double lumen endotracheal anes-thesia to can reduce hemodynamic fluctuations and stress reaction during the extubation.

Objective To investigate the clinical application of robot-assisted laparosocopic ureterolithotomy.Methods The clinical data of 28 cases(15 males and 13 females),aged 42(18～72),of laparosocopic ureterolithotomy with AESOP system(computer Motion,USA) was analyzed.Of the 28 cases,18 patients had upper ureter stones and 10 had middle ureter stones.Results All procedures were completely performed by robot assisted laparosocopic ureterolithotomy.The operative time was ranged from 35 to 150 min(averaged 50 min) and the intraoperative blood loss was ranged from 20 to 50 ml(averaged 30ml).The postoperative hospital time was 3 to 5 days and no ureter stricture or recurrent calculus was found during the follow-up period(2～13 months).Conclusion The ZEUS AESOP system has the characteristics of high intelligence and humanization.The robot-assisted laparoscopic ureterolithotomy is effective,safe and precise.

Objective To observe the TCM syndromes of acute exacerbation of chronic obstructive pulmonary disease (COPD) with malnutrition. Methods TCM Syndromes Questionnaire of Acute Exacerbation of COPD was formulated with TCM clinical epidemiology methods. Totally 220 cases of hospitalized patients met the inclusion criteria were divided into two groups, 120 cases of malnutrition and 100 cases of non-malnutrition. The clinical data were observed and syndrome elements of malnutrition group and non-malnutrition group were analyzed to discuss the rule of syndromes in acute exacerbation period. Results In addition to respiratory system, the frenquency of symptoms such as weight loss, shortness of breath, easy cold, aversion to wind and cold, poor appetite, abdominal distension, constipation, belching, dizziness and tinnitus, tooth loose and hair loss, soreness and weakness of waist and knees significantly increased in COPD with malnutrition, mainly involving in syndromes of spleen deficiency and incoordination between spleen and stomach. In patients with acute exacerbation of malnutrition COPD, the single syndromes were 36 cases (30%), the composite syndromes were 84 cases (70%). The simple excess syndromes were 38 cases (31.67%), the simple deficiency syndromes were 23 cases (19.17%), and the intermingled deficiency and excess syndromes were 59 cases (49.17%). Conclusion Patients with acute exacerbation of COPD with malnutrition are mainly composite syndromes and the intermingled deficiency and excess syndromes. Spleen deficiency and incoordination between spleen and stomach may be the important pathogenesis of COPD with malnutrition.

Objective Pulmonary embolism is a common cardiovascular emergency with the characteristics of high incidence,high mortality.This study compared pulmonary artery catheter thrombolysis with peripheral intravenous thrombolysis for acute pulmonary embolism in the mid-term clinical efficacy.Methods From June 2011 to September 2015,68 patients were given pulmonary artery interventional therapy,54 cases received peripheral intravenous thrombolysis;discharged patients were followed up for 3-12 months to evaluate the curative rate,effective rate,recurrence rate and the incidence of complications.Results Follow up rate was 79.5％.The cure rate of the treatment group was higher than that of the control group (47.3 ％ vs 23.8 ％,P ＜ 0.05);The significant effective rate of the treatment group was higher than that of the control group (81.8％ vs 52.4％,P ＜ 0.05);The incidence of Chronic pulmonary hypertension (1.8％) was lower than that of the control group (16.7％);There was no significant difference in improvement rate,recurrence rate and mortality.Conclusion The medium-term efficacy of pulmonary artery catheter directed thrombolysis is superior to that of peripheral intravenous thrombolysis;it can effectively reduce the incidence of chronic thromboembolic pulmonary hypertension.

Objective:To study the collapse of the contralateral femoral head after the total hip arthroplasty (THA) in patients with bilateral steroid-induced femoral head necrosis leg-length discrepancy (LLD) influences.Methods:A total of 108 patients with bilateral steroid-induced femoral head necrosis who were treated in Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2014 to June 2016 underwent THA surgery on the hip joints that had symptoms and developed to Association Research Circulation Osseous (ARCO) Ⅲ. At the same time, the non-surgical hip-preserving treatment of the non-collapsed femoral head developed to the ARCO Ⅱ stage was performed. The follow-up period was 2 years, and 98 cases were finally included. According to the size of the leg-length discrepancy [LLD<3 mm group ( n=50), LLD≥3 mm group ( n=48)] and the type of leg-length discrepancy[non collapse side longer group ( n=58) and shorter group ( n=58)], the collapse of the femoral head and the THA were observed. Results:Finally, a total of 56 cases of femoral head collapse occurred in the non collapse side of the hip, of which 50 cases underwent THA within 24 months. There were significant statistical differences in THA and femoral head collapse between LLD<3 mm group and LLD≥3 mm group, non collapse side longer group and non collapse side shorter group ( P<0.05). The 2-year survival rate without collapse in the LLD<3 mm group and LLD≥3 mm group were 52.1% and 34.0%, respectively, and the 2-year survival rates in the longer and shorter non-collapsed limb groups were 56.9% and 22.5%, respectively. Compared with patients with moderate lesions, the survival rate of femoral heads in patients with larger lesions was lower ( OR: 4.25, 95% CI: 1.55-11.26; P=0.003). LLD<3 mm group ( OR: 0.24, 95% CI: 0.06-0.50; P<0.01) or non collapse side longer group ( OR: 0.13, 95% CI: 0.04-0.29; P<0.01) had lower risk of contralateral femoral head collapse after THA. Conclusions:For patients with bilateral steroid-induced femoral head necrosis who have collapsed lateral THA, postoperative leg-length discrepancy extremities is a potential risk factor for collapse of non-collapsed femoral head. LLD<3 mm and avoiding shortening of the uncollapsed limb may reduce the risk of collapse of the uncollapsed femoral head.

Diffusion tensor imaging (DTI), which responds with the diffusion of water molecules in spinal cord white matter, may be used to detect the integrity of the spinal cord fiber bundles and the pathological changes after injury. It is sensitive in acute and chronic spinal cord injury, such as cervical spondylotic myelopathy, multiple sclerosis, brain damage secondary spinal cord injury, spinal nerve root damage, and so on. In basic studies, DTI can reveal the microstructure and pathological changes of the injured spinal, and be correlated with behavioral assessment, which involved mice, monkeys, calves, cats, swines, dogs, and so on.

Objective To explore the effect of salmon calcitonin on osteoporosis induced by spinal cord injury. Methods 100 patients with osteoporosis induced by spinal cord injury from September 2011 to September 2014 in our department were included. They were randomly divided into control group (n=50) and observation group (n=50). The control group received vitamin D3 only, while the observation group received vitamin D3 combined with salmon calcitonin on the basis of rehabilitation physiotherapy, for 6 months. Visual Analogue Scale (VAS) of pain was evaluated in different periods. The bone mineral density (BMD) of lumbar spine and femoral neck, the parathyroid hormone (PTH), bone gla protein (BGP) and 1,25- dihydroxy vitamin D3 (1,25-(OH)2D3) were tested and recorded. Results The VAS score was lower in the observation group than in the control group 1, 2, 3 and 6 months after treatment (P<0.001). The BMD of lumbar spine and femoral neck was significantly higher, the PTH and BGP were significantly lower and the 1,25-(OH)2D3 was significantly higher in the observation group than in the control group after treatment (P<0.001). Conclusion Combination of salmon calcitonin can effectively reduce the bone pain and improve the BMD in patients with osteoporosis induced by spinal cord injury.