Objective To study the effect of BCG polysaccharide nucleic acid combined with Tripterygium wilfordii polyglycoside(TWP) on inflammatory factors and T cell subsets in patients with chronic urticaria. Methods From January 2015 to January 2017,84 patients of chronic urticaria in Gujiao Central Hospital were selected in the research. The patients were randomly divided into observation group and control group,with 42 cases in each group. The control group was treated with conventional therapy,and the observation group was treated with BCG polysaccharide nucleic acid combined with TWP. The levels of IL－2,IL－4,IL－10,peripheral blood interferon－γ(IFN－γ),T cell subsets ( CD+4, CD+8, CD+4/CD+8) were observed, and the clinical efficacy was compared. Results After treatment,the total effective rate of the observation group was higher than that of the control group[41(97. 62% ) vs. 36(85. 71% )](χ2=3. 896,P＜0. 05). The levels of IL－2 and IFN－γ in the observation group were higher than thoseinthecontrolgroup[(314.54±45.47)ng/Lvs.(285.04±46.84)ng/L,(310.25±32.80)ng/Lvs.(265.14± 28. 11)ng/L](t=2. 928,6. 767,all P＜0. 05). The levels of IL－4 and IL－10 in the observation group were lower thanthoseinthecontrolgroup[(18.65±3.14)ng/Lvs.(26.09±4.52)ng/L,(57.65±6.34)ng/Lvs.(63.74± 6. 82)ng/L](t=8. 760,4. 238,all P＜0. 05). The levels of CD+4,CD+4/CD+8in the observation group were higher thanthoseinthecontrolgroup[(39.86±6.96)% vs.(34.44±7.06)%,(1.60±0.14) vs.(1.34±0.15)](t=3. 543,8. 212,all P＜0. 05). The level of CD+8in the observation group was lower than that in the control group [(24.34±3.99)% vs.(27.24±4.33)%](t=3.191,P＜0.05).Conclusion BCG polysaccharide nucleic acid combined with TWP in the treatment of chronic urticaria can effectively increase peripheral blood IFN－γ and IL－2 levels,decrease IL－4,IL－10 levels,improve levels of inflammatory cytokines and T cell subsets( CD+4,CD+8and CD+4/CD+8),the efficacy is safe and reliable,it is worthy of application and promotion.

Objective To investigate the clinical value of penetrating-suture type pancreaticojejunostomy (PPJ) after pancreaticoduodenectomy (PD).Methods The clinical data of 77 patients who received pancreaticoduodenectomy from Taixing People's Hospital from June 2002 to March 2012 were retrospectively analyzed.Of all the patients,34 received PPJ after PD (PPJ group),and the other 43 patients received PJ anastomosis (control group) based on the texture and size of the pancreas,pancreatic duct diameter (duct-to-mucosa pancreaticojejunostomy for pancreatic duct diameter ≥ 4 mm,end-to-end or binding pancreaticojejunostomy for pancreatic duct diameter ≤3 mm).Pancreatic fistula was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula,including grade B or C pancreatic fistula with clinical value.Patients were followed-up through outpatient examination and telephone interview till May 2012.Data were presented by x ± s or median (range) and the t-test and Wilcoxon rank-sum test were used to evaluate quantitative data with or without normal distribution,respectively.Qualitative data were analyzed using Pearson x2 test or Fisher's exact test.Results The mean diameter of the pancreatic duct was 3 mm for both the PPJ group and the control group.The external drainage via the pancreatic duct stent was not used in the PPJ group,compared with 4 cases in the control group,showing a statistically significant difference between the 2 groups (x2=3.632,P ＜ 0.05).The duration of pancreaticojejunostomy was 12 minutes (range,8-25 minutes) in the PPJ group,while no records in the control group.The operation time and intraoperative blood loss in the PPJ group and the control group were (304 ± 60)minutes and (475 ± 75) mL,(304 ± 60) minutes and (500 ± 97) mL,respectively.Twenty-four (70.6％) patients in the PPJ group and 29 (67.4％) patients in the control group received intraoperative blood transfusion,with volume of 400 mL (range,300-800 mL) and 600 mL (range,300-1 200 mL),respectively.The median duration of postoperative hospital stay were 18 days (range,11-32 days) in the PPJ group and 20 days (range,9-44 days) in the control group.None of these comparisons were statistically significant between the 2 groups (t =1.293,0.619,x2=0.088,Z =0.165,0.074,P ＞0.05).The rate of grade B or C pancreatic fistula were 0 for the PPJ group and 27.9％ (12/43) for the control group,and the mortality rate of patients who had pancreatic fistula were 0 and 11.6％ (5/43) for the PPJ group and the control group,with statistical significance (x2=11.232,4.237,P ＜0.05).The overall incidence of bile leakage,peritoneal bleeding and delayed gastric emptying in the PPJ group and the control group were 5.9％ (2/34),2.9％ (1/34),5.9％ (2/34) and 11.6％ (5/43),7.0％ (3/43),14.0％ (6/43),with no significance difference (P ＞0.05).Fifty-six patients were followed up after operation from 9 months to 5 years.Pancreatic duct dilation was detected by imaging examination for 26 patients in the control group.Conclusions PPJ is a simple and feasible approach with better clinical efficacy after PD.

Objective To evaluate the clinical value of laparoscopy in adrenal surgery.Methods From December 2000 to May 2006,86 cases of adrenal space-occupying lesion received laparoscopic adrenalectomy via transperitoneal(n=1),retroperitoneal(n=81) and hand-assisted transperitoneal(n=4) approach,respectively.Results All the operations were successful without conversion to open surgery and severe complications.The mean operative time was 72 min(range,50-175 min).The mean blood loss was 54 ml(range,15-120 ml).The postoperative hospital stay was 6.3 d(range,5-8 d).Imaging examinations revealed no tumor recurrence and metastasis during the mean follow-up period of 26.5 months(range,2-65 months)in 86 patients.The symptoms of patients with functional tumor was alleviated or disappeared.Conclusions Laparoscopic adrenalectomy has advantages of minimal invasion,less blood loss,and quicker recovery,and it should be the fist choice for most adrenal space-occupying lesions.

Systemic lupus erythematosus is a diffuse connective tissue disease, which is mediated by autoimmune mechanisms.It results in multiple autoanti-bodies in the serum and injury organs and systems.Modern medicine uses glucocorticoid as the main medicine in treating systemic lupus erythematosus.Glu-cocorticoid is pure yang product, not only wil it injure yin and qi for using long time, but also disturb syndrome type of traditional Chinese Medicine of SLE for using it in large number.In the starting phase of using glucocorticoid, if the patients present manifestation of toxic heat flourishing, we should clear heat and remove toxicity.If the patients present manifestation of yin deficiency and internal heat, we should nourish yin and clear heat.If the patients pre-sent manifestation of stagnated heat stagnation, we should remove toxic heat and blood stasis.In reduction stage of using glucocorticoid, patients present manifestation of qi and yin deficiency.Then we should benefit qi and nourish yin. In maintenance stage of using glucocorticoid, patients present manifesta-tion of yang deficiency of spleen and kidney.So we should warm the kidney and invigorate the spleen.During the whole course of treating, we should also care for blood stasis and toxin.The clinicians should also remove toxic heat and blood stasis depend on the changing of syndrome. Using GCS in treating SLE should depend on the syndrome differentiation and choose the right Traditional Chinese Medicine in order to reach the clinical effect.

Objective To investigate characteristic of CT findings for peritoneal metastases.Methods The CT manitestations of 48 cases with pathologically proved peritoneal metastases were analysed. Results ①Ascites was seen in 32 cases, to make up 66.7%. ②Changes of omentum were found in 16 cases, to make up 33.3%; In it, cake sign of omentum were in 8 cases, nodular sign of omentum were in 5 cases, cystic sign of omentum were in 2 cases, opacity sign of omentum was in 1 case. ③Changes of mesentery were in 14 cases, to make up 29.2%. ④Thickening of the parieral peritoneurmar were in 12 cases, to make up 25%. ⑤Thickening of small intestine wall and moving of intestine were in 2 cases, to make up 4.2%.Conclusion CT is a valuable method for the diagnosis of peritoneum metastatic tumor.

Objective To investigate the features and prognosis of noncompaction of ventricular myocardium (NVM) in Chinese.Methods The clinical features of 16 NVM patients were analyzed and 15 patients were followed prospectively.Results Familial occurrence were found in seven patients.Six came to hospital for heart failure and two for chest pain.Arrhythmias were found in six patients.Six patients were asymptomatic.Fifteen patients were followed prospectively for 52.06?8.46 months.In the follow-up,three patients died and heart failure occurred in one asymptomatic patients.One patients accepted permanent pacemaker.Five patients were still asymptomatic.Conclusion In general,the prognosis of NVM is poor,but the outcome is better in patients without symptom.The early diagnosis is important.

Objective To investigate the early diagnosis and rational treatment of popliteal artery injury so as to im-prove the lower limb salvage rate. Methods The clinical and follow-up data integrity of 25 patients with popliteal artery injury was systematically studied. In these patients , 19(76%)cases were blunt injury and 6(24%) cases were penetrating injury. The combined injury included open fracture in 10 cases(40%) ,the knee joint dislocation with closed fracture of lower limb in 13(52%),nerve injury in 5(20%) and venous injury in 3(12%),respective-ly. The cause of delayed diagnosis and relationship between prognosis and type of injury, complications, the dura-tion from injured to treatment time were analyzed. Results 20 cases were operated to repair the popliteal artery. Endovascular treatment in 5 cases, the blood supply completely recovered (64%) in 16 cases, improved in 3 cases (12%) , 6 cases (24%) amputed, respectively. Rate of amputation within 6~8 hours was significantly lower than that of the more than 8 hours from the injuried to treatment time ( P<0. 05 ) . Amputation rate in blunt injury and combined injury was significantly higher than that of sharp injury ( P<0. 05 ) . Conclusion The duration from inju-ry to surgery more than 8 h, combined with knee joint dislocation and wound around knee is a major cause of mor-bidity. Operation with arterial thrombectomy is the main treatment, while endovascular treatment is a complementa-ry treatment to save the lower limb.

BACKGROUND:Adipose-derived stem cel s have different sources, but it is unclear whether these cel s from different sources have difference in their biological properties.
OBJECTIVE:To detect the in vitro proliferation and chondrogenic differentiation of adipose-derived stem cel s derived from renal fat capsule and groin.
METHODS:Adipose-derived stem cel s from renal fat capsule and groin of rats were isolated, cultured and identified. MTT assay was used to detect in vitro proliferation ability of these cel s. Passage 3 cel s were under chondrogenic induction for 2 weeks. After induction, the expression of type II col agen was observed by immunofluorescence detection, and RT-PCR was employed to detect the expression levels of Aggrecan and type II col agen mRNA in the two groups.
RESULTS AND CONCLUSION:After primary culture and passage, adipose-derived stem cel s from the renal fat capsule and groin of rats exhibited similar morphology, and over 95%of cel s expressed CD44 in the two groups. Adipose-derived stem cel s from two sources showed an S-shaped growth curve in vitro and were positive for type II col agen. After RT-PCR detection, the expression levels of Aggrecan and type II col agen mRNA had no difference in adipose-derived stem cel s from renal fat capsule and groin (P>0.05). Experimental results show that adipose-derived stem cel s from both renal fat capsule and groin exhibit stable growth, rapid proliferation and chondrogenic differentiation under orient induction in vitro, indicating there is no difference between these cel s from two sources.

Objective To evaluate the clinical application of the tissue Doppler imaging (TDI) in investigating the cardiac longitudinal systolic function in the patients with type 2 diabetes mellitus. Methods Forty-two patients with type 2 diabetes mellitus and 25 volunteers underwent TDI. The long axis myocardial peak systolic velocity (Sm), displacement (Dm) and strain rates (SRs) of 18 segments in different left ventricular walls were measured.Results The Dm and SRs of left ventricular wall in diabetic group dramatically decreased (P<0.01). Meanwhile, the diabetic combined hypertension group had much lower Sm of ventricular middle segments than the control group (P<0.05).Conclusion The stain rate and tissue tracking are sensitive and reliable to evaluate the early local cardiac systolic function in the patients with diabetes mellitus. TDI can be used as an noninvasive method to detect early systolic dysfunction.

Objective To assess the feasibility of evaluation of coronary flow reserve (CFR) for left anterior descending (LAD),left circumflex (LCx),and right coronary posterior descending artery(PDA) as well as diagnostic accuracy for patency of each branches by transthoracic Doppler echocardiography (TTDE). Methods CFR of main coronary artery branches at the distal sites were studied by TTDE with adenosine infusion (140 μg · kg-1 · min-1) in 439 consecutive patients with suspected coronary heart disease. The relations between CFR and stenosis rates of coronary bifurcations were analyzed. Results Twenty-eight of LAD,12 of LCx and 21 of PDA were occluded in 439 patients. The success rate of CFR assessment of LAD, LCx and PDA were 96.8% (395/411), 74.9% (320/427), 83.0% (347/418)respectively. Then CFR≤2.0 and CFR≤1.7 were chosen as the criteria of coronary stenosis (≥50 %) and severe stenosis(≥75%). The sensitivity and specificity of detection of LAD,LCx and PDA stenosis were 81% and 87% ,64% and 82%, 79% and 85%, respectively. The sensitivity and specificity of diagnosis of LAD, LCx and PDA severe stenosis were 86% and 81%, 70% and 85%, 81% and 82%, respectively.Conclusions CFR evaluation of main coronary artery branches has high feasibility and can provide valuable information for relevant vessel patency.