This paper analyzes the disadvantages of traditional elevator used in tonsillectomy.Through clinical practice and on the basis of the structure of traditional elevator,a new elevator is designed which is similar to traditional one in appearance but different in its head,middle and end parts.With this elevator,the operative field is improved and thus operating period is decreased.

BACKGROUND: Hematic protective has arisen widely attention in China and abroad due to the serious blood contamination and transfusion related diseases.OBJECTIVE: To observe hematic protective effect of hypertonic solution chloride hydroxyethy140 injection (HSH) on acute hypervolemic hemodilution (AHH) in maxilla Lefort Ⅰ osteotomy.METHODS: Totally 40 patients were randomly divided into the experimental and control groups, with 20 patients in each group. All patients were operated under tracheal intubation general anesthesia, in the experimental group, 4 Ml/kg HSH was infused with speed of 10 Ml/min, and the infusion was finished within 30 minutes. There was no treatment in the control group. Blood routine examination (including hematocrit, hemoglobin, blood platelets count) and routine coagulation test (including platelet, partial thromboplastin time, fibrinogen) was performed at the points of before AHH (T_0), at the end of AHH (T_1), 30 min after AHH (T_2),60 min after AHH (T_3), 3 hours after AHH (T_4), 1 day after operation (T_5), and 3 days after operation (T_6), respectively.Simultaneously, the capacities of blood transfusion, liquor transfusion, hemorrhage and urine during operation was recorded. RESULTS AND CONCLUSION: All the patients were included in the final analysis. Compared to the control group, the capacity of blood transfusion in the experimental group was smaller than that of the control group (P<0.05), with greater urine volume (P<0.05). However, the differences of liquor transfusion and hemorrhage had no significance (P>0.05). After controlled hypotension,the heart rates of patients at T_2 and T_3 were obvious increased than that of T_1 (P<0.05), the systolic pressure, diastolic pressure,and mean arterial pressure were significantly decreased (P<0.05). At T_1, T_2 and T_3 points, the heart rates of patients in the experimental group were greater than that of the control group (P<0.05). The systolic pressure, diastolic pressure, and mean arterial pressure had no dramatically differences between two groups (P>0.05). After AHH, the hematocrit and hemoglobin were obviously decreased in the experimental group at T_1, T_2, T_3 and T_4 points (P<0.05), with more blood platelets count and prolonged partial thromboplastin time (P<0.05). Compared to the control group, the Na~+, Cl~-was increased in the experimental group at T_1 and T_2 points (P<0.05), with greater hematocrit and hemoglobin at the T_5 and T_6 points (P<0.05). The results demonstrated that HSH can decrease or avoid transfusing blood in maxilla Lefort Ⅰ osteotomy.

Iatrogenic bile duct injury (IBDI) is a severe complication in general surgery, especially during laparos-eopic cholecystectomy. Many factors may cause IBDi, in which the conscientiousness, skill and experience of the surgeons play a more important role than the abnormal anatomy and patholo-gical changes of the patient. The Bismuth's classification, which originated from the era of open surgery, does not cover the whole spectrum of bile duct injuries. Strasberg's classification made a supplement by including other types of extrahepatie bile duct injuries. The variation of opportunities leads to different thera-peutic strategies. When the injuries are diagnosed intraopera-tively, a conversion to open surgery is the option of choice, and the prosthesis should be performed by a more experienced surgeon. If the bile duct injury is diagnosed in the early stage after operation, therapeutic principles are as follows: biliary peritonitis often required an emergency reoperation, while extra-peritoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is steno-sis, sometimes followed by fistula. Sufficient preoperative prepa-ration is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient.

Objective To investigate the relationship between that vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) distribution were in the small intestine mucous membrane and that urea and creatinine were eliminated from intestine inrenal failure rat used Shenfushu and atropine treatment.Methods Sprague-Dawely (SD) rats with 5/6 kidney resection were randomly divided into Shenfushu treatment group,Shenfushu + atropine treatment group,pathological control group,and sham operation group for the normal controls.Treatment groups were drenched for eight weeks.Before and after treatment,the concentration of blood urea nitrogen (BUN),serum creatinine (Scr),the fecal urea and fecal creatinine were detected; the expression levels of VEGF and MVD in the small intestinal were detected with small intestinal biopsy immunohistochemical method.The relationship between that expression of VEGF and MVD,and that concentration of BUN,Scr,the fecal urea,and fecal creatinine was analyzed.Results VEGF in the Shenfushu treatment group,Shenfushu + atropine treatment group,and pathological control group was (20.72 ± 1.8) pu,(24.32 ± 1.54) pu,and (28.69 ± 1.82) pu,respectively; MVD was (274.27 ± 10.62)/mm2,(332.71 ± 10.96)/mm2,(436.42 ± 13.70)/mm2,respectively.Expressions of small intestinal VEGF and MVD in two treatment groups were increased significantly than the control group.The concentrations of BUN and Scr were significantly decreased with a negative correlation with the expressions of VEGF and MVD.The concentrations of fecal urea nitrogen and fecal creatinine were significantly increased with a positive correlation with the expressions of VEGF and MVD (P ＜0.05).The concentrations of BUN and serum Cr in the Shenfushu + atropine group were significantly changed more than Shenfushu group (P ＜ 0.05).Conclusions Shenshuaikang and atropine could enhance the expression of VEGF in the small intestinal mucosa,increase microvascular density,promote the elimination of urea nitrogen and creatinine from the intestinal tract to decrease the concentrations of BUN and Scr.Those effects were more obvious with two drugs in combination.

A clinically isolated syndrome(CIS) is a term that describes a first clinical episode in which a patient has symptoms and signs suggestive of an inflammatory demyelinating disorder of the central nervous system.And it often affects optic nerves,the brainstem,or the spinal cord,and 30％-70％ of the CIS patients may develop multiple sclerosis(MS).Disease-modifying treatments may delay the development from CIS to MS.Their use in CIS is limited because of uncertain long-term clinical prognosis,treatment benefits and adverse effects.This article reviews the advances of predictive markers of conversion to MS after a CIS,in order to provide the reference for clinical treatment.

[Objective] To observe the cure effect of Qianlishu Pil combined with hydrochloric acid doxycycline and Hytrine on chronic nonbacterial prostatitis(CNP). [Method] Select 264 cases of CNP, randomly divide them into control and treatment groups, n=132 for each. The control group was treated with hydrochloric acid doxycycline and Hytrine for 2m; the treatment group, with combined Qianlieshu Pil with hydrochloric acid doxycycline and Hytrine for 2m;make analysis and comparison of 2 groups after treatment. [Result] The effect and clinical signs recovery time were better in treatment group than control one; the total effective rate was 88.9% for treatment group, and 53.8% for control one, the comparison of them had difference of statistical meaning. [Conclusion] The combination of Qianlieshu Pil , hydrochloric acid doxycycline and Hytrine has marked cure effect on CNP.

Objective To analyze the causes of chronic cough. Results Totally 146 patients with chronic cough were diaguosed according to the diagnostic routine based on the guideline on diagnosis and treatment of chronic cough established by Chinese Medical Association, which included medical history, medical examination, X-ray or CT of paranasal sinus or chest, lung function, gastroscope, sputum cytology classification. The final diagnosis was made based on clinical manifestation examination findings and a positive response to therapy. Conclusion The cause of chronic cough was defined in 93.2% of the patients, and multiple causes: Cough variant asthma (n = 45,30.3%), postnasal drip syndrome,PNDs (n = 27, 18.5%), gastroesophageal reflux cough(n = 21,14.4%), post infection cough(n = 16,10.9%), ensinophilic bronchitis(n = 13, 8.9%), drug induced cough(n = 10,6.8%), unidentified cough(n = 10,6.8%). Conclusion Complex etiology of chronic cough,be specific therapeutic effect,and its clear cause is the key to treatment.

Objective:To investigate the influence of Xuefu Zhuyu Decoction ( XZD) contained Drug-Serum on the expression of TLR4/NF-κB signals and LOX-1, TNF-α, ICAM-1, VCAM-1 in HUVECs, and to study its possible anti-atherosclerotic mechanism.Methods:HUVECs was cultured in vitro and divided equally into the normal group ,the model group,the ATV group and the XZD group in random.HUVECs were stimulated with LPS for 2 h,then treated separately with the drug-serum and atorvastatin for 24 h,finally measured the expression of TLR 4, MyD88, TRAF-6, NF-κB, LOX-1, TNF-α, ICAM-1 and VCAM-1 mRNA with real-time PCR,the expression of TLR4,NF-κB,LOX-1,TNF-α,ICAM-1 and VCAM-1 protein were analyzed by Western blot method .Results:Protein and mRNA expressions of TLR4,MyD88,TRAF-6,NF-κB,LOX-1,TNF-α,ICAM-1 and VCAM-1 increased significantly after LPS stimulation(vs normal control group,P<0.01),Xuefu Zhuyu Decoction decreased the high expression of TLR 4,MyD88,TRAF-6, NF-κB,LOX-1,TNF-α,ICAM-1 and VCAM-1(vs model group,P<0.05 ).Conclusion:Xuefu Zhuyu Decoction can block the high ex-pression of TLR4 and its downstream signal transduction pathway and the high expression of LOX -1, TNF-α, ICAM-1 and VCAM-1.Maybe it′s the mechanism of Xuefu Zhuyu Decoction exert the function of anti-artherosclerosis.

Objective To evaluate the diagnosis and treatment of children′s appendicitis.Methods Retrospective analysis of 2390 children patients with appendicitis undergoing appendectomy, and pathological classification was made.Results The simple type was in 237 cases (9.91%); purulent in 1798 (75.23%), among which 568 (31.59%) cases suffered perforation; Gangrenous in 212 (8.87%), with perforation in 159 (71.36%).During this period, there were 192 cases (7.4%) of appandiceal abscess.The perforation rate was 30.12%.That was 41.46% in children under 1-year of age, 44.96% in 1 to 4-year of age; 28.17% in 5 to 10 year of age; and 20.94% in over 10-year of age.Conclusion The incidence of postoperative pathology-proved simple type appendicitis is in inverse proportion to that of perforation.As a whole it reflects the strictness in which an individual case is indicated for a laparotomy.It is our believe that an incidence of 30% perforation is acceptable.

Three-dimensional conformal radiation therapy(3D-CRT) and intensity-modulated radiation therapy(IMRT) are becoming important parts for research of treatment in esophageal carcinoma patients.The advances of dosimetric study in 3D-CRT,IMRT of esophageal carcinoma and the evaluation indices are reviewed.