Objective To explore feasibility of laparoscopic hepatectomy for hepatic hemangioma.Methods Twelve patients were treated by laparoscopic hepatectomy, including left lateral lobectomy in 5 cases and local liver resection in 7 cases. Three cases of hepatic hemangioma associated with gallbladder stone were performed cholecystectomy synchronously. Results Laparoscopic procedures were successfully performed in all 12 cases. The mean operative time was 155 min. The mean blood loss was 230 mL. The mean postoperative hospital stay was 8 days. The pospostoperative recovery was smooth except that 1 case had pulmonary infection. During a follow-up of 6-20 months for 12 cases,there were no recurrence. Conclusion Laparoscopic hepatectomy for hepatic hemangioma is safe and feasibile with good effect under the condition of strict indication selection and experienced surgeons operating.

Objective To evaluate the impact of endoscopic sphincterotomy (EST) and bile duct exploration with open surgery on immune function and inflammatory response.Methods Fifty-one patients with choledocholithiasis were divided into endoscopy group ( EG,n =24) and laparotomy group ( LG,n =27 ) according to the patients' will from June 2010 to February 2012.Procalcitonin( PCT),C-reactive protein (CRP),immunoglobulins (IgA 、lgG 、IgM ) and T lymphocyte (CD4、CD8 ) of peripheral blood were examined preoperatively and on the 1st,3rd and 5th day postoperatively.Results Compared with preoperative levels,postoperative levels of serum PCT and CRP were higher in both groups (P ＜0.01 ),but on the 3rd day after the operation,the changes of PCT and CRP levels in the two groups were not significantly different ( P ＞ 0.05 ).Postoperative levels of serum immunoglobulins of two groups were lower than preoperative levels (P ＜ 0.01 ),but the IgA and IgM levels in EG were significantly higher than those in the LG (P ＜ 0.05),and IgG levels in the two groups were not significantly different after surgery ( P ＞ 0.05 ).Compared with preoperative levels,postoperative levels of CD4,CD8 and CD4/CD8 ratio in EG were only slightly decreased (P ＞ 0.05 ),and returned to the preoperative levels on the 5th day postoperatively,but postoperative levels of these variables in LG were decreased significantly ( P ＜ 0.05).Postoperative levels of CD4,CD8 and CD4/CD8 ration of the two groups were significantly different (P ＜ 0.05).Conclusion Both EST and bile duct exploration with open surgery can inhibit immune function and induce inflammation,but the procedure of EST,which may mainly affect humoral immune function,has impact on immune function less intensely.

Objective To evaluate clinical efficacy of tigecycline alone or in combination with other antimicrobials in treating infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB).Methods Patients with hos-pital-acquired pneumonia (HAP)and/or bloodstream infection in the intensive care unit of a hospital between Janu-ary 2013 and June 2014 were selected,efficacy of tigecycline treatment was analyzed.Results Of 25 patients with CRAB infection,21 were with HAP,2 with bloodstream infection,and 2 with both HAP and bloodstream infec-tion.13 cases were multidrug-resistant Acinetobacter baumannii (MDRAB), 10 cases were extensively drug-resistant Acinetobacter baumannii (XDRAB).The susceptibility rate of 25 CRAB isolates to tigecycline was 84%. After treated with tigecycline,white blood cell count(WBC),C-reactive protein (CRP),and procalcitonin (PCT) all significantly decreased (all P<0.01).The clinical effective rate,bacterial clearance rate,and 30-day mortality were 68.00% (17/25),66.67%(14/21),and 28.00% (7/25)respectively;effective rate of 21 cases of HAP was 76.19% (16/21),1 case of bloodstream infection was effective,2 cases of HAP combined bloodstream infection died.Conclusion Tigecycline is effective in the treatment of HAP caused by CRAB,but the therapeutic effect on bloodstream remains uncertain,further research is needed.

Objective To study the clinical value of PgCO_2 measurement on the patients in ICU.Methods PgCO_2 were continuous measured 24 hours by using air-automated tonometry for 50 cases admitted in ICU.The heart rate,blood pressure,MAP,CVP,SpO_2,artery blood gas were measured at the same time.According to acute physiologic and chronic health evaluation(APACH Ⅱ) and MODS mark,the patients were divided into 2 groups,high-risk group and light-risk group.20 cases suffered from malignant tumour without functional failure of the organs were looked on as compared group.The results of measurement of every group were compared.Results Comparing with the three groups,the results of PgCO_2,Pg-aCO_2,Pg-etCO_2 were significantly different,but the Pg-aCO_2 and Pg-etCO_2 were the same.Conclusion PgCO_2 is an effective index for observing the conditional change of the high-risk cases.PgCO_2≥45mmHg,Pg-aCO_2≥15mmHg may be considered as a predictive signal that the patient well appears functional failure or death.Pg-etCO_2 may substitute Pg-aCO_2 as a continuous measurement index.

Objective To evaluate the feasibility,safety and efficacy of laparoscopic appendectomy for acute appendicitis with previous abdominal surgery.Methods The clinical data of 253 patients with acute appendicitis undergoing laparoscopic surgery was retrospectively studied from Feb.2009 to Jun.2012,including 177 patients without previous abdominal surgery (no previous abdominal surgery group,NPAS group),76 patients with previous abdominal surgery (previous abdominal surgery group,PAS group).Parameters studied were conversion rates,operation time,blood loss,complications rate,length of hospital stay and the intestine function recovery time between two groups.Results The conversion rates were no significant difference between NPAS group and PAS group.The operation time of NPAS group and PAS group was (40.5 ± 12.3) minutes and (62.6 ± 14.2) minutes (P ＜0.05).The blood loss,intestine function recovery time,complications rate,and length of hospital stay were no significant minutes between NPAS group and PAS group after operation (P ＞ 0.05).Conclusions Previous abdominal surgery prolongs the operation time of laparoscopic appendectomy,but history of abdominal surgery has no significant effect on laparoscopic surgical outcome,which may indicate that laparoscopic surgery for acute appendicitis with previous abdominal surgery is safe and effective and still has the adventages of less trauma,faster recovery.

Objective To analyze the operative therapeutic effect of proximal femoral nail antirotation blade (PFNA),dynamic hip screw (DHS) and femoral proximal locking compression plate (LCP)internal fixation in treatment with femoral intertrochanteric fracture of the aged.Methods Seventy-three aged patients with femoral intertrochanteric fracture were divided into 3 groups according to different internal fixation method:PFNA group (30 cases) was treated with PFNA internal fixation,DHS group (22 cases) was treated with DHS internal Fxation,LCP group (21 cases) was treated with LCP internal fixation.The operative time,intraoperative bleeding volume,fracture healing time,bad limb load time and hip joint function score were compared among the 3 groups.Results The operative time in PFNA group,DHS group and LCP group was (73.9 ± 8.5),(82.3 ± 10.6),(79.5 ± 11.2) min,there was statistical difference between PFNA group and DHS group (P ＜ 0.05),but there was no statistical difference between PFNA group and LCP group (P＞ 0.05).The intraoperative bleeding volume in PFNA group was significantly lower than that in DHS group and LCP group [(160.2 ± 15.6) ml vs.(208.4 ± 20.2) and (216.6 ml ± 24.9) ml],there was statistical difference (P ＜0.05).The fracture healing time and bad limb load time in PFNA group were significantly shorter than those in DHS group and LCP group [(97.4 ± 5.8) d vs.(101.2 ± 4.2),(110.0 ±8.3) d and (78.0 ±5.4) d vs.(85.9 ±7.6),(90.8±6.0) d],furtbermore DHS group were significantly shorter than those in LCP group,there were statistical differences among the 3 groups (P ＜ 0.05).There were no statistical differences in excellent and good rate of hip joint function score among the 3 groups (P ＞ 0.05).Conclusions PFNA is the ideal therapeutic method for femoral intertrochanteric fracture of the aged.It has better curative effect compared to the DHS and LCP,and has less surgical trauma and can shorten the recovery time.

Objective To explore the clinical effect and feasibility of cold cycle microwave ablation combined with laparoscopic hepatectomy for hepatic hemangioma.Methods Thirteen cases of hepatic hemangiomas were treated with cold cycle microwave ablation combined with laparoscopic hepatictomy,and their clinical data were analyzed retrospectively from March 2015 to October 2017 in the First People's Hospital of Jiangxia District of Wuhan City,including 5 males and 8 females with an average age of 52 years and age range of 45-68 years.The course of disease was 18 months to 8 years,with an average of 4.2 years.The clinical data were retrospectively analyzed and the operation time,intraoperative blood loss,postoperative hospital stay,liver function changes and complications were recorded.The data were analyzed using SPSS 17.0 statistical software,and measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD).Results The operations of the 13 cases were successful,including 7 cases of single hepatic hemangioma (the lesions were located in segments 11,111 and Ⅳ) and 6 cases of multiple hepatic hemangioma (the lesions were located in segments Ⅱ,Ⅲ,Ⅳ,Ⅶ and Ⅷ).No hepatic portal occlusion was performed during the operation.The operation time was (135.4 ± 35.8) min,intraoperative blood loss was (95.2 ± 22.7) ml,the postoperative hospital stay was (6.4 ± 0.8) d.On the first postoperative day,alanine aminotransferase was (354.2 ± 75.4) IU/L,and aspartate aminotransferase was (382.7 ± 68.5) IU/L,during the first week after surgery,alanine aminotransferase and aspartate aminotransferase both decreased to the normal range,and no serious complications such as bile leakage or hemorrhage occurred after surgery.No recurrence was observed after 6 to 12 months of follow-up.Conclusions Under the premise of strict control of surgical indications,laparoscopic cold-circulation microwave ablation combined with hepatectomy for hepatic hemangioma is safe and feasible.It can simultaneously treat multiple lesions,and cold-cycle microwave ablation can effectively reduce intraoperative bleeding with a minimally invasive effect.

Objective To observe the effectiveness of injecting mouse nerve growth factor ( mNGF) on the recovery of hand motor function among patients with cubital tunnel syndrome. Methods A total of 138 patients with moderate to severe cubital tunnel syndrome were randomly divided into groups designated as A, B and C, each of 46. Twenty micrograms of mNGF was injected daily 1 mm from the ulnar nerve at the cubital tunnel for the patients of group A and the injection site was moved 1 mm distally everyday along the nerve , but injected intramuscularly for those in group B. Those in group C received 500 μg of mecobalamin injected intramuscularly 3 times a week. The whole intervention consisted of two 4-week phases, with an interval of 2 months. Before and after the intervention, the function of internal hand muscles, hand function recovery rates and any electrophysiological changes in the ulnar nerve were measured and compared between the two groups. Results All of the patients showed significant improve-ment in hand muscle function and neuroelectrophysiology. The incidence of had muscle atrophy, Tinel′s sign, posi-tiveness in the paper clamping test and claw hand all significantly improved compared with before the treatment in all three groups. The average Disability of Arm Shoulder and Hand score in group A after the treatment was significantly higher than the group B and group C averages. The average ulnar nerve conduction velocity, incubation period and amplitude of group A after the treatment were all significantly better than before the treatment and better than the other groups′averages. After the treatment, the average hand function recovery in group A reached 91％, significantly high-er than in groups B ( 76％) and C ( 59％) . Conclusion Injecting mNGF next to the ulnar nerve is superior to in-jecting it intramuscularly in promoting the recovery of the ulnar nerve and hand function for patients with moderate to severe cubital tunnel syndrome.

Objective To compare the effects of different anesthetics on the recovery of neurologi-cal function after intracranial aneurysm embolization. Methods One hundred patients of both sexes with aneurysmal subarachnoid hemorrhage, aged more than 18 yr, with body mass index of 18. 5-24. 0 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ and WFNS grade Ⅰ-Ⅳ, with the thick-ness of subarachnoid hemorrhage more than 4 cm, were divided into 2 groups (n= 50 each) using a random number table: propofol group (group P) and sevoflurane group (group S). After anesthesia induction, group P received intravenous infusion of propofol 100-300 μg·kg-1 ·min-1 , while the end-tidal sevoflu-rane concentration was maintained at 1. 4％-3. 5％ in group S. Immediately before induction (T0 ), imme-diately after the end of induction (T1 ), immediately after successful embolization of aneurysm (T2 ) and at 1, 2, 3 and 5 days after surgery (T3-6 ), central venous blood samples were collected for determination of plasma neuron-specific enolase and S100β protein concentrations by enzyme-linked immunosorbent assay. The development of postoperative cerebral vasospasm and delayed ischemic neurological deficit was recorded. The patients were followed up, and the Glasgow outcome score and occurrence of newly developed cerebral infarction were recorded within 6 months after surgery. Results There was no significant difference in the concentrations of plasma neuron-specific enolase and S100β protein at each time point, incidence of postop-erative cerebral vasospasm and delayed ischemic neurological deficit, or Glasgow outcome score and inci-dence of newly developed cerebral infarction within 6 months after surgery between two groups (P>0. 05). Conclusion Propofol and sevoflurane exert no effect on the recovery of neurological function after intracra-nial aneurysm embolization.

BACKGROUND:Intervertebral disc degeneration is the basis of spinal degenerative diseases;however,there is no effective treatment. OBJECTIVE:To investigate whether sinomenine can inhibit interleukin-1β-induced apoptosis in nucleus pulposus cells and its molecular mechanism. METHODS:Rat nucleus pulposus cells were cultured in vitro by trypsin combined with type II collagenase digestion,and the cell growth curve was plotted.An appropriate sinomenine concentration was determined using the cell counting kit-8 kit.Nucleus pulposus cells were divided into control group,sinomenine group,interleukin-1β group,sinomenine+interleukin-1β group,zinc protoporphyrin group,zinc protoporphyrin+sinomenine group,zinc protoporphyrin+interleukin-1β group,and sinomenine+zinc protoporphyrin+interleukin-1β group.Proliferative activity,reactive oxygen species content,apoptosis rate,and heme oxygenase-1 expression in nucleus pulposus cells were detected. RESULTS AND CONCLUSION:The rat nucleus pulposus cells cultured in vitro were polygonal,triangular,and short wedge-shaped,and the cell growth showed an"S"curve.The cells grew slowly in the first 3 days of culture,rapidly in 4-6 days,and slowly again in 7-8 days.The cells then entered the"platform stage"where the number of cells no longer increased.The proliferative activity of myeloid cells showed no significant changes when the concentration of sinomenine was≤80 μmol/L(P>0.05).Interleukin-1β significantly reduced the proliferative activity of nucleus pulposus cells,increased the content of reactive oxygen species and led to apoptosis(P<0.01).Sinomenine intervention not only promoted heme oxygenase-1 expression(P<0.05)but also inhibited interleukin-1β-induced decrease in proliferative activity and increase in reactive oxygen species content and apoptosis rate in nucleus pulposus cells(P<0.05).These effects could be reversed by zinc protoporphyrin(P<0.01).