Objective To study the variation of serum IL-6,IL-8,TNF-α and CRP in perioperative patients with pancreatitis. Methods 39 caaes in perioperative patients with pancreatitis in our hospital from January 2008 to 2010 April were selected as observation group,and 39 healthy people were selected as control group,and the serum IL-6,IL-8,TNF-α and CRP of the observation group before the treatment and after the treatment at 4h,at the first day, at the second day and the seventh day and the control group were detected, and the results were analyzed and compared. Results The serum IL-6,IL-8 ,TNF-α and CRP of the observation group before the treatment were higher than those of the control group( all P ＜ 0. 01 ) there were significant differences, and the levels of the observation group at 4h,at the first day,and at the second day showed decreasing,the levels compared to those of the control group( all P ＜ 0. 05 ) there were significant differences, the levels of the observation group at seventh day were compared to those of the control group(all P＞0. 05) there were no significant differences. Conclusion It was regulation of the variation of serum IL-6, IL-8 ,TNF-α and CRP in perioperative patients with pancreatitis, and tit could provide evidence for the treatment.

Objective To investigate the correlation between immediate postoperative platelet count with liver failure after partial hepatectomy in patients with hepatocellular carcinoma.Methods The clinical data of 71 patients with hepatocellular carcinoma who underwent liver resection at the Hepatopancreatobiliary Surgery Department of Nanjing Drum Tower Hospital from July 2013 to August 2015 were retrospectively analyzed.The clinical diagnosis was confirmed by pathology of the resected specimens.Based on postoperative platelet count within 2 h,the patients were divided into the low platelet count (PLT ＜ 100 × 109/L) group (n =24,33.8％) and the normal platelet count (PLT ≥ 100 × 109/L) group (n =47,66.2％).The correlations between immediate postoperative platelet count with serum indexes including serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and direct bilirubin (DBil) were analyzed,and the incidences of posthepatectomy liver failure was also evaluated in these two groups.Results There was no re-operation and perioperative death in this study.Among the 71 patients,25 patients (35.2％) developed postoperative complications (grade Ⅰ to Ⅲ),and 8 patients (11.3％) suffered from postoperative liver failure (grade A).When compared with the normal platelet count group,the low platelet count group had significantly increased risks of postoperative liver failure (29.2％ vs 2.1％,X2 =11.618,P ＜ 0.05),increased postoperative peaks of ALT,AST,TBil and DBil levels [(462.5 ±135.7)U/L vs (307.9 ± 192.6) U/L,(440.0 ± 163.3) U/L vs (265.8 ± 155.8) U/L,(29.5 ±9.1) μmol/L vs (17.9 ±8.8) μ mol/L,t =3.507,4.385,5.129,P ＜0.05,respectively] and longer normalization time of liver function.Multiple Logistic regression analyses revealed that an immediate postoperative low platelet count was an independent risk factor of posthepatectomy liver failure.Conclusions The platelet count was associated with the incidence of postoperative liver failure after partial liver resection in patients with hepatocellular carcinoma.Patients with an immediate postoperative low platelet count suffered from a high incidence of posthepatectomy liver failure and delayed liver function recovery.

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.

BACKGROUND: Hip arthroplasty and internal fixation with intramedullary cannulated screws are mainly used for senile femoral neck fractures. However, osteoporosis can usually lead to failure in internal fixation.OBJECTIVE: To analyze the joint function after fixed with intramedullary cannulated screws in elderly patients with femoral neck fractures, and to explore the factors related to functional recovery.METHODS: Clinical data of 89 patients with femoral neck fractures undergoing internal fixation with intramedullary cannulated screws after 2-year follow-up were analyzed retrospectively. The sex, age, Garden type, bone mineral density, body mass index, screw distribution, reduction index, operation time, bearing time and Harris hip scores were analyzed. Rank related analysis and accumulative Logistic regression analysis were performed on SPSS18.0 software. RESULTS AND CONCLUSION: (1) Normal Q-Q plot and normality test results indicated that the Horris scores in all patients after 2-year follow-up presented with skewed distribution (P=0.000). (2) Rank related analysis showed that age,Garden type, bone mineral density, and reduction index were related with Harris score (P < 0.05 or P < 0.01). (3) Accumulative Logistic regression analysis showed that the independent variables including age, Garden type, bone mineral density, and reduction index made significant effect on Harris hip scores. (4) To conclude, age, Garden type,bone mineral density, and reduction index are important factors for functional recovery of the hip after fixed with intramedullary cannulated screws.

The neuroanatomical basis of meridian effects is one of the focuses of acupuncture mechanism studies. Meridian effects depend mainly on the generation, conduction, integration and output of acupuncture information in the acupoint, spinal cord and brain.The neural tracer technique is a basic method in neurobiology. This article presents recent years' advances in the application of the neural tracer technique to acupuncture field and summarizes the types of neural tracer used in acupuncture studies and regularities in the distribution of neurons and their fibers related to labeled meridians and acupoints in spinal segments and brain regions to provide methodological reference for studies on neurobiological mechanism of acupuncture effects.

Objective To investigate the clinical efficacy of double locking mini-plates for fixation of the comminuted fracture of the first metacarpal base.Methods Twenty-four patients with the comminuted fracture of the first metacarpal base were treated by double locking mini-plates in our hospital from January 2013 to January 2016.They were 17 males and 7 females,from 27 to 65 years of age (average,33.5 years).By the Green classification,6 cases were type Ⅰ,13 cases type Ⅱ and 5 cases type Ⅲ.All the fractures were closed.The average time from injury to surgery was 2.3 days (from 8 hours to 7 days).After open reduction via the palmar-radial incision,the fracture was fixated with 2 mini-plates,one locking T-plate on the radial side and one straight locking plate on the dorsal side.Fracture healing time,pain and finger function were followed up postoperatively.Visual analogue scale (VAS) was used to evaluate the pain at 12 months and scoring for digital total range of motion to assess the function of the affected finger at the final follow-up.Results The 24 patients obtained follow-up for 8 to 28 months (average,18 months).All the Fractures healed after 9 to 12 weeks (average,10.5 weeks).The VAS scores at 12 months ranged from 0 to 3 (average,1.5).The function of the affected finger at the final follow-up was excellent in 20 cases and good in 4,giving an excellent to good rate of 100％.Two patients complained of pain after frequent motion of the finger.No complications like skin problems,dislocation of the first metacarpal base,implant failure,necrosis or irritation of the soft tissue were observed during follow-up.No angulation or rotational deformity occurred after fracture union.Conclusion Fixation with double locking mini-plates can effectively treat comminuted fractures of the first metacarpal base,because it can provide rigid stabilization which promotes early functional exercise of the finger,and prevents joint stiffness as well.

Objective:To explore the clinical features, treatment, prognosis and genetic mutation in neonatal congenital hyperinsulinemia(CHI).Methods:Neonates with CHI admitted to the neonatal intensive care unit of Hebei Provincial Children′s Hospital from February 2017 to August 2020 were selected, and their clinical characteristics, diagnosis and treatment, prognosis and genetic mutation were retrospectively analyzed.Results:A total of seven neonates were enrolled.The average gestational age was(38.1±1.5)weeks with two cases gestational age<37 weeks.The mean birth weight was(3 608±906)g with three cases birth weight>4 000 g. The common clinical manifestations included lethargy, poor feeding, cyanosis, seizures, and tremble.Non-specific manifestations were observed in two premature infants, whose blood glucose were found very low during the routine monitoring at 1 hour and 3 hours after birth respectively.Among the seven cases, six cases needed high glucose infusion rate(GIR)[>10 mg/(kg·min)] to maintain the serum glucose at the normal level from the beginning.Only one case needed lower GIR[3-5 mg/(kg·min)] on admission while gradually increased to 8 mg/(kg·min) maximumly during hospitalization.All seven neonates were treated with diazoxide orally, and two cases(2/7) were effective, including one case who discontinued the drug at six months after birth with normal blood glucose level.The remaining five neonates(5/7) were diazoxide resistant due to mutations in the ABCC8 gene encoding the K ATP+ -channel of the pancreatic beta cell and then treated with octreotide.Two cases(2/5) of them were effective to octreotide and the other three cases(3/5) were both diazoxide and octreotide resistant.One case died after withdrawal from the treatment and the other one lost follow-up.The other five cases were followed up until now.Normal neurological development were found in three cases.Two cases were found with epilepsy and moderate developmental delay in language and social competence ability during the follow up.Mutations in ABCC8 were the most common in seven cases, of which six cases were heterozygous mutation of ABCC8 and one case was heterozygous mutation of GLUDI. Conclusion:The clinical manifestations of CHI are non-specific.The blood glucose level of the high-risk neonates should be timely monitored.Neonates who needs lower GIR[<8 mg/(kg·min)] at the early stage can not be completely excluded CHI.Some CHI cases may self-resolved after several months.Molecular diagnosis can identify the pathogenic genes, which is important to achieve accurate diagnosis and treatment, and thus improve the prognosis of patients with CHI.

Objective:To identify the risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children.Methods:The data of 171 children were retrospectively analyzed who had been treated for flexed supracondylar humerus fractures of Wilkins type Ⅲ from January 2013 to December 2021 at Department of Orthopaedics, Children's Hospital of Jiangxi Province and Children's Hospital of Fudan University Anhui Hospital. They were divided into a reduction failure group (35 cases) and a reduction success group (136 cases). Factors such as fracture height, age, body mass index, ulnar-radial offset direction, obvious axial rotation of the distal fracture fragment, combined ulnar nerve injury, and time from injury to operation were listed as risk factors. The independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures were identified by univariate analysis of variance and multi-variate logistic regression analysis.Results:The average age of 171 children was (7.8±2.6) years. There were 151 cases of radial deviation and 20 cases of ulnar deviation, 120 high type fractures and 51 low type fractures, and 20 cases of combined ulnar nerve injury and 115 cases of obvious rotation of the distal fracture fragment. The one-way ANOVA showed statistically significant differences between the reduction failure group and the reduction success group in terms of age, obvious rotation of the distal fracture fragment, and ulnar nerve injury ( P<0.05), but no significant differences in fracture height, body mass index, ulnar-radial offset direction, or time from injury to operation ( P>0.05). Multivariate logistic regression analysis showed that obvious rotation of the distal fracture fragment ( OR=3.287, 95% CI: 1.136 to 9.513, P=0.028) and combined ulnar nerve injury ( OR=6.439, 95% CI: 2.262 to 18.327, P=0.001) were risk factors for failure in closed reduction. Conclusion:As obvious rotation of the distal fracture fragment and combined ulnar nerve injury may be independent risk factors for failure in closed reduction of flexed supracondylar humerus fractures of Wilkins type Ⅲ in children, they should arouse more attention in the treatment of such fractures.

Objective: To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma. Methods: The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome. The mean age of the entire cohort was 62(40-87)years, with 74 males and 22 females. There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma), 83 cases of bladder carcinoma, and 12 cases of lymph node metastasis. There were 77 cases of primary onset and 19 cases of recurrence. 68 cases in single focus group and 28 cases in multiple group. There were 29 cases in non infiltrative T_a stage, 42 cases in infiltrative lamina propria T₁ stage, 16 cases in infiltrative muscle T₂ stage, and 9 cases in extra-muscular≥T₃ stage. At least 3ml of peripheral blood was collected after fasting for at least 8 hours, After cleavage and centrifugation, immunomagnetic beads were added, folate probe was added, and then amplification was carried out. Then the copy number of CTCs in each ml of blood was calculated. Logistic linear regression was used to analyze the risk factors of lymph node metastasis. Results: The mean CNC of all patients was 12.3±7.3; the mean CNC of ≤62 years old group was 10.8±4.2; the mean CNC of >62 years old group was 13.7±9.2; the mean CNC of initial cases was 11.5±5.3; the mean CNC of recurrent cases was 15.5±12.2. Age (P=0.135) and frequency of onset (P=0.087) had no effect on the number of CTCs. The average CNC of single focus group was 10.5±5.2, multiple focus group was 16.5±9.7, T_a stage group was 8.2±2.3, T₁ stage group was 12.0±4.4, T₂ stage group was 16.4±6.8, and ≥T₃ stage group was 19.5±16.6. The number of lesions (P<0.001) was significantly correlated with pathological T stage (P<0.001) and the number of CTCs. Univariate regression analysis showed that T stage (P<0.001) and the number of CTCs (P=0.02) might be correlated with lymph node metastasis; multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P=0.002). Conclusions CTCs can be used to predict lymph node metastasis of urothelial carcinoma.

Objective:To investigate the icariin on cognitive function and astrocytic pyroptosis in hemorrhagic shock resuscitation model mice.Methods:Forty-eight SPF grade C57BL/6 mice (male) were randomly divided into four groups ( n=12 in each group): Sham operation control group (Group C), hemorrhagic shock and resuscitation group (Group H), hemorrhagic shock and resuscitation plus icariin group (Group HI) and hemorrhagic shock resuscitation plus icariin and SSK1 group (Group HIS, SSK1 was a phosphorylation agonist of mitogen-activated protein kinase p38(p38MAPK). The mice in Group H, HI and HIS were subjected to hemorrhagic shock and resuscitation model by bleeding and retransfusion via left femoral vein; the mice in Group HI and HIS were administered with icariin (10 mg/kg) intragastrically for 7 days; the mice in Group C and H were administered with the same amount of normal saline containing dimethyl sulfoxide(DMSO). The mice in Group HIS were administered with SSK1 (0.5 mg/kg) intraperitoneally, but the mice in Group C, H and HI were only administered with the same amount of normal saline containing DMSO.At 15 days after resuscitation, novel objective recognition test and fear conditioning test were used to assess cognitive dysfunction of mice.Microtubule-associated protein 2(MAP2), a specific marker protein of neurons reflecting astrocytic pyroptosis in the hippocampus of mice, were detected by immunofluorescence assay so as to assess neuronal injury and astrocytic pyroptosis.The levels of IL-1β, IL-18, the ratio of phosphorylated p38MAPK to total p38MAPK in the hippocampus were evaluated by Western blot.SPSS 21.0 software was used for data analysis, multiple samples among groups were compared by one-way ANOVA, and SNK- q test was used for further pairwise comparison. Results:The results of new object recognition test showed that the difference of new object recognition index among the four groups was statistically significant ( F=50.75, P<0.05). The new object recognition indexes in H group(22.7±6.9), HI group(40.1±7.0) and HIS group (22.5±7.5) were significantly lower than that in C group (58.5±11.2). The index in HI group was higher than that in H group, while the index in HIS group was lower than that in HI group (all P<0.05). The results of the fear conditioning test showed that there was a statistically significant difference in the percentage of freezing time among the four groups of mice ( F=60.54, P<0.05). And the percentage of freezing time in H group((21.8±5.0)%), HI group ((38.4±7.4) %)and HIS group((21.3±4.2)%)were lower than that in C group((49.1±7.0)%), which in HI group was higher than that in H group ( P<0.05)and which in HIS group was lower than that in HI group(all P<0.05). The results of immunofluorescence showed that there were significant decreases of MAP2 intensity ((35.3±9.3)%, (63.3±6.1)%, (28.7±10.3)%) but increases of pyroptotic astrocytes ((24.5±4.2)%, (9.3±1.5)%, (22.1±3.3)%) in the H, HI and HIS groups compared with those of C group ((106.7±19.7) %, (3.4±2.0)%). There was an increase of MAP2 intensity but a decrease of pyroptotic astrocytes in the HI group compared with those in H group, and there was a decrease of MAP2 intensity but an increase of pyroptotic astrocytes in the HIS group compared with those of HI group (all P<0.05). The Western blot results showed that there were significant increases of IL-1β, IL-18, the ratio of phosphorylated p38MAPK to total p38MAPK in the H, HI and HIS groups compared with C group, there were decreases of IL-1β, IL-18, the ratio of phosphorylated p38MAPK to total p38MAPK in the HI group compared with H group, and there were increases of IL-1β, IL-18, the ratio of phosphorylated p38MAPK to total p38MAPK in the HIS group compared with those in HI group (all P<0.05). Conclusion:Icariin alleviates hemorrhage shock and resuscitation-induced cognitive dysfunction and astrocytic pyroptosis in mice, and the mechanism may be associated with inhibition of phosphorylated p38MAPK.