Objective To investigate the clinical effect of intramuscular dextromethorphan and tramadol premedication for postoperative analgesia.Methods 60 cases of ASA Ⅰ～Ⅱ underwent surgical procedures of extremitas inferior were divided into 3 groups randomly.Patients in every group were provided with dextromethorphan 20mg,tramadol 2mg/kg and normal sodium 4ml(control group) respectively.All patients received PCEA analgesia postoperatively.The postoperative visual analogue scale(VAS),ramay score,consumption of paregonic and adverse reactions were observed.Results After operation,VAS score in group of dextromethorphan was lower than that in control group significantly(P

Objective To evaluate the significance of laparoscopy in the diagnosis and treatment of unexplained acute right lower abdominal pain in women. Methods Clinical data of 52 women with unexplained acute right lower abdominal pain from April 1999 to April 2004 were retrospectively analyzed. Results Diagnosis was clarified under laparoscope in all the 52 patients, including 28 cases of acute appendicitis, 18 cases of acute pelvic inflammatory disease, 3 cases of ovarian cyst pediculotorsion, 2 cases of right tubal pregnancy, and 1 case of Crohn’s disease with iliac perforation. With exception of a conversion to open surgery in 3 patients, laparoscopic treatment was successfully completed in the remaining 49 patients. No surgical complications occurred. The patients were discharged from the hospital 2~6 days postoperatively. Conclusions Laparoscopy is a timely, safe and effective alternative for the diagnosis and treatment of unexplained acute lower right abdominal pain in women.

Objective To study the effect of topical tacrolimus (FK506) on the survival of the xenogeneic transplanted hair follicles from human scalp to Wistar rats. Methods In our study, Wistar rats were used as recipients and human as donor. The black hair follicles of human scalp were harvested, and then the xenogeneic grafts were transplanted to white Wistar rats on the back. 20 couples of rats were divided in 2 groups: topical tacrolimus group (group A), and blank control group (group B). After operaton, we compared the survival time of hair follicles and their histologic outcomes in order to verify the practicability of xenogeneic transplantion of hair follicles, and the topical application of tacrolimus results.Results The mean survival time of group A was longer [(49. 9 ±7. 1) days] as compared to group B [(13. 1±1. 2) days]. The longest survival time was 65 days in group A and 14 days in group B, respectively. By comparison of the results we found that topical tacrolimus prolonged the survival time of the xenotransplanted hair follicles significantly and that tropical medication could not avoid rejection. Conclusions The immune privilege function dependent on the hair follicle anagen and axillary topical tacrolimus, can prolong the survival time of the xenogeneic transplanted hair follicles in rats significantly.

Objective To study the effect of reducing no-reflow after PCI treatment by early using Tirofiban and suction catheter in AMI patients .Methods 76 cases of patients were divided into group A (38 cases) and group B(38 cases) .The group A began to use Tirofiban with suction catheter to aspiration after coronary guidewire entering ,the suction were used in group B when the thrombus burden became exacerbation after balloon dilation .In addition ,chosen 38 cases of AMI patients treated with Tirofiban af-ter balloon dilation as group C .The influence of different treatment options to no-reflow and slow blood flow ,cardiovascular adverse events and the incidence of bleeding were observed .Results Group A compared with other two groups ,the no-reflow and slow flow rate had statistically significant differences (P< 0 .05) ,but there was no statistically significant differencebetween group B and group C(P>0 .05) .After three different surgical treatments ,the incidence of bleeding complications had no significant difference (P>0 .05 .The occurrence of adverse cardiovascular events had statistically significant between A group and C (P<0 .05) ,but there was no statistically significant difference between group B and group C (P<0 .05) .Conclusion Three kinds of treatment all have certain effect to reduce no-reflow in emergency PCI of AMI ,but early use of tirofiban with suction catheter in treatment of emergen-cy treatment has great clinical significance to reduce no-reflow .This study provides an effective treatment plan to reduce no-reflow in PCI for AMI .

In vivo tumor imaging technique method based on bioluminescence principle was established to evaluate the anti-tumor effect of paclitaxel mixed micelle (PMM). MDA-MB-231 tumor cells with luciferase reporter vectors were firstly implanted into nude mice, and subsequently the luciferase substrate was regularly injected during intraperitoneal administration of PMM. Then the tumor size, growth and the intensity of light signals were monitored with in vivo imaging technique. The method of luciferase tumor in vivo imaging could be real-time, reliable and exact in labeling and reflecting the growth of tumors, and the observed results were consistent with that by conventional method, so it would be a feasible approach to study anti-tumor effect of drugs. The anti-tumor effect of paclitaxel mixed micelle was observed by this method, and the results showed that this formulation could inhibit growth of tumor, and the anti-tumor rate of it was about 85%.

Objective The purpose of this study was to explore common complications and their clinicopathological features in pediatric liver transplantation.Methods Clinical and pathological data of 240 liver biopsies from 168 children that conducted liver puncture from January 2015 to May 2018 in Tianjin First Central Hospital was retrospectively analyzed.We comprehensively analyzed incidence rate and pathological features of various complications,and correlations between acute rejection and C4d staining result or Banff score.Results A total of 86.67％ (208/240) liver biopsies could be definitely diagnosed with incidence rate of main complications in descending order as follows:T cell mediated rejection (TCMR) 60.57％ (126/208),drug-induced liver injury (DILI) 17.31％ (36/208),biliary complication 8.17％ (17/208),vascular complication 3.37％ (7/208),ischemia/reperfusion injury (IRI) 2.88％ (6/208),antibody mediated acute rejection (AMR) 1.92％ (4/208),HBV infection 1.92％ (4/208),non-alcoholic fatty liver disease (NAFLD) 1.44％ (3/208),chronic rejection (CR) 0.96 ％ (2/208) and HCV infection 0.48 ％ (1/208).TCMR and AMR in acute rejection (AR) accounted for 96.92％ (126/130) and 3.08％ (4/160),and into(portal-based,PB)type TCMR accounted for 96.03％(121/126) with the detectable rate of BP type subtype TCMR of 26.45％(32/121)within 30 d.There were 65.87％ (83/126)、25.40％ (32/126) 和4.76％ (6/126) of BP TCMR samples with "Banff ACR RAI" score within 3-5,6-7 and 8-9,and RAI score was negatively correlated with postoperative time (r =0.127,P =0.084).The incidence rate of central perivenulitis (CP) and portal eosinophils infiltration (PEI) in BP TCMR was 63.63％ (77/121) 和43.80％ (53/ 121),respectively,additionally,the PEI level was positively correlate with RAI score (P＜0.05).CP TCMR and AMR occurred within 30d-365 d and 8 d-180 d,respectively postoperative,while,the two CR occurred at 1095 d and 1335 d postoperative,and significant correlation was strikingly observed between rejection subtype and postoperative time (Z =9.231,P =0.026).C4d positive rate was 10％ (24/240),which was associated with Banff score and postoperative time,besides,C4d score was also correlated with rejection subtype and RAI score.The occurrence of DILI was mainly at time of ＜90 d or ＞180 d postoperative,and the detectable rate of biliary complication within 180 d postoperative was 82.35％ (14/17),IRI Appear in ＜30d.Hepatic artery complication account for nearly 57.14％ (4/7),occurrence time is ≤90 d.Occurrence of HBV infection,CMV infection and NAFLD were mainly at ＞365 d,＜90 d and ＜365 d,respectively.Conclusion There were lots of differences in clinical and pathological features among multi pediatric liver transplantation complications.Liver puncture plays an important role in rejection subtype classification and grading,as well as in non-rejection complications identification.

Objective:To investigate the feasibility of combination of en-bloc resection of bladder tumor (ERBT) with the NBI(narrow band imaging) flexible cystoscopy, immunotherapy and chemotherapy in bladder-preserving treatments(called as TMT) for patients with stage T 2 bladder carcinoma. Methods:We retrospectively reviewed and analyzed a series of 16 patients with pT 2N 0M 0 pathologically confirmed. All patients are male with a median age of 63yr(56, 73yr). The American Association of Anesthesiologists scored ≤Ⅱ in 12 cases and Ⅲ in 4 cases. There were 9 cases with smoking history, 5 cases with hypertension, 3 cases with diabetes, and 2 cases with heart disease. The results of preoperative tissue biopsy were all urothelial carcinoma. All patients were taken lithotomy position and performed ERBT with NBI imaging technique and thulium-laser energy platform under general anesthesia. The tumor was brown and the surrounding normal mucosa was cyan in color. The procedure was ensured with a minimal tumor margin of 1cm and minimal rection depth to the deep musculi, and with the acquirement for the en-bloc specimen of which the basal site was marked afterwards, the patients all took a full length of chemoimmunotherapy (four cycles of Tislelizumab combined with Gemcitabine and cisplatin regimens) followed by a secondary ERBT. The perioperative data from sequential operations including complications were comprehensively analyzed for evaluating the therapeutic outcome and safety. All patients received a follow-up to detect efficacy and safety of the treatment with the primary end point of pCR, downgrading rate and objective response rate. Results:All operations were successfully completed. There was no obturator reflex, severe bleeding or grade Ⅱ bladder perforation, only 4 patients got a grade Ⅰ bladder perforation. The postoperative 30-day complication occured in 2 cases(1 pt with hematuresis, 1 pt with bladder irritation). The pathologic complete response rate and tumor downstaging rate were 100%. One patient recurred during a median follow-up of 13.0 months (6, 36 months).Conclusions:The En Bloc Resection of Bladder Tumor with the narrow band imaging (NBI) flexible cystoscopy has several remarkable advantages, including a better intra-operative visual, a lower complication rate and tumor residual. The combination of ERBT with immunotherapy and chemotherapy lead to affirmative curative effect and the feasibility for clinical application is relatively high.

Inflammatory bowel disease （IBD）， consisting of ulcerative colitis and Crohn's disease， is a chronic relapsing inflammatory gastrointestinal disease closely associated with immune dysfunction. The pathogenesis of IBD is closely related to genetic susceptibility， immune system dysfunction， environmental change， and intestinal microbial dysbiosis. Modern research has found that macrophage polarization plays an important role in the development of IBD and can affect the level of inflammatory response， intestinal mucosal repair， and intestinal microbial balance， making it a potential target for IBD treatment. Increasing evidence suggests that traditional Chinese medicine and its active components can regulate macrophage polarization through multiple pathways and balance the M1/M2 macrophage ratio， thus inhibiting inflammatory response， promoting intestinal mucosal repair， and slowing down the progression of IBD. This article summarized the biological processes and targets involved in macrophage polarization and discussed its impact on IBD. It also provided a brief overview of the latest research on how traditional Chinese medicine and its active components can improve IBD by regulating macrophage polarization， so as to provide new directions and strategies for the clinical application of traditional Chinese medicine in IBD treatment.

Artemisinin and its derivatives (ARTs) were reported to display heme-dependent antitumor activity. On the other hand, histone deacetylase inhibitors (HDACi) were known to be able to promote heme synthesis in erythroid cells. Nevertheless, the effect of HDACi on heme homeostasis in non-erythrocytes remains unknown. We envisioned that the combination of HDACi and artesunate (ARS) might have synergistic antitumor activity through modulating heme synthesis. studies revealed that combination of ARS and HDACi exerted synergistic tumor inhibition by inducing cell death. Moreover, this combination exhibited more effective antitumor activity than either ARS or HDACi monotherapy in xenograft models without apparent toxicity. Importantly, mechanistic studies revealed that HDACi coordinated with ARS to increase 5-aminolevulinate synthase (ALAS1) expression, and subsequent heme production, leading to enhanced cytotoxicity of ARS. Notably, knocking down significantly blunted the synergistic effect of ARS and HDACi on tumor inhibition, indicating a critical role of ALAS1 upregulation in mediating ARS cytotoxicity. Collectively, our study revealed the mechanism of synergistic antitumor action of ARS and HDACi. This finding indicates that modulation of heme synthesis pathway by the combination based on ARTs and other heme synthesis modulators represents a promising therapeutic approach to solid tumors.