To analyze the influence of related factors on recurrent hemorrhage after operation of hypertensive intrac-erebral hemorrhage,and investigate the countermeasures against recurrent hemorrhage. 124 patients with surgical treated hypertensive intracerebral hemorrhage were analyzed retrospectively. Logistic regression analysis was applied to analyze the function of various possible factors that might induce recurrent hemorrhage. The incidence of recur-rent postoperative hemorrhage was 16. 1% . Univariate logistic analysis disclosed that timing of operation,the hem-orrhage site and coagulation factor disorders,difficulties met during the operation and inadequate hemostasis,and postoperative blood pressure fluctuation were significantly related with recurrence of hemorrhage(P < 0. 05). Multi-variate logistic regression analysis showed that timing of operation,difficulties met during the operation and inade-quate hemostasis and postoperative blood pressure fluctuation were risk factors of recurrent hemorrhage(P < 0. 05). The optimal operative time,strict hemostasis in operation and appropriate postoperative blood pressure control are important measures in preventing recurrent hemorrhage.

Objective To explore the value of gastroendoscopy check-up early after non-surgical treatment of patients with gastroduodenal perfolation.Methods The patients suspected of perforated gastroduodenal ulcer on hospital admission underwent non-surgical treatment were enrolled.After cured clinically,performed gastroendoscopy at different time periods.Results Among 133 patients underwent gastrointestinal endoscopy,129 cases(97.0%)were diagnosed gastroduodenal ulcer,3 cases(2.3%)were diagnosed gastric carcinoma,1 case (0.8%)Was confirmed duodenal diverticulum,no compilcations occurred due to endoscopy.The 6 cases that had surgical indications had be implemented the early surgical treatment. Conclusions After non-surgical treatment of patient with gastroduodenal perforation,timely gsstroendoscopy can truly show pathologic changes with gastroduodenal perforation.So endoscopy is beneficial under condition appropriate time seleetion for confirmed the eliology of PGD,treatment promptly targeted etiology and understanding the mechanism healing the perforation as non-surgical treatment.

Background and purpose:Colorectal carcinoma(CRC) is a major cause of cancer-related mortality. In the 1990s, several fi rst-line phase Ⅲ trails showed a signifi cant improvement in result with the addition of CPT-11(irinotecan, which is a specifi c inhibitor of topoisomerase Ⅰ) to FU-LV combination therapy(FOLFIRI).We observed the survival rate, effi cacy and adverse reaction of the combination chemotherapy of irinotecan plus folinic acid/continuous 5-? uorouracil bimonthly FOLFIRI regimen as second chemotherapy in treating advanced colorectal adenocarcinoma. Methods:Sixty patients with histologically proved advanced colorectal adenocarcinoma whose disease had progressed after treatment with first-line oxaliplatin or other chemotherapeutics agents were included to receive at least 2 cycles of chemotherapy with irinotecan 180 mg/m2 day 1 and folinic acid 200 mg/m2 iv,5-FU 400 mg/m2 iv bolus,days 1 and 2, 5-FU 600 mg/m2 iv infusion over 22 hours, days 1 and 2.Treatment was repeated every two weeks. Results:All patients were assessable for toxicity and 58 patients were evaluable for treatment response. The non-hematological toxicity was mild. Most was grade Ⅰ or Ⅱ. Only two patients experienced grade Ⅲ diarrhea and one patient experienced grade Ⅲ nausea and vomiting. There were no cases with grade Ⅳ toxicity. The most common hematological toxicity was neutropenia. Grade Ⅲ neutropenia were observed in fi ve patients. There was no case of febrile neutropenia. Based on intention to treat analysis, there were no complete responses (CR), 14(24.14%) partial response (PR), and 30 (51.72%) stable disease. the median time to disease progression was 6.09 months. The median overall survival was 9.65 months. Conclusions:Bimonthly irinotecan in combination with folinic acid and 5-fluorouracil was active with acceptable toxicities and a prolonged survival time in retreated colorectal cancer.

Objective To explore the clinical efficacy and surgical techniques of vaginal sacrospinous ligament fixation,which was used for treatment of uterine prolapse and vaginal prolapse of the top.Methods 25 patients with uterine prolapse and vaginal vault prolapse were treated with VSSLF,and its feasibility and effiency was analyzed.Results All patients were successfully conducted the surgical indexing method based on POP-Q,25 cases of uterine prolapse,vaginal anterior and posterior wall prolapse and urinary incontinence and other symptoms all had been corrected.There was no intraoperative and postoperative bleeding or pelvic organ injury in surgry.25 patients recovered well after operation,postoperative morbidity,not observed in other complications associated with surgery.All the patients were followed up for 24 months,patients'cervix 4 cm from the hymen edge,related symptoms disappeared or improved significantly.Conclusion Vaginal sacrospinous ligament fixation is a safe,simple,effective and minimally invasive surgery for uterine prolapse and vaginal prolapse of the top.

Objective To evaluate the application of dual-source CT (DSCT) using low-dose technology in diagnosing complex congenital heart diseases. Methods The DSCT data of 31 cases with complex congenital heart diseas-es conifrmed by operation were retrospectively analysed and classiifed into four groups:group A(≤4 months old, n=12); group B (>4 months old~1 year old, n=3);group C (>1 year~6 years old, n=8) and group D (>6 years old, n=8). Results The diagnosis conformation rate of DSCT with surgery were 94.59%. The diagnostic conformation rate of intracardic anormalies using DSCT was 92.86%. And the diagnostic conformation of DSCT in patients with abnormal connection of atrium or ventri-cle to great vessels and the extrocardic anormalies was 95.65%. The average effective dose in each group were 1.16±0.06 mSv, 1.28±0.07 mSv, 1.96±0.54 mSv and 2.77±0.38 mSv, respectively. The ratio of the high quality images was 90.32%. Con-clusions The application of low dose technology in DSCT can clearly display the anomalies, and signiifcantly reduce the radiation dose without losing image quality as well.

Objective To investigate the association between variable number of tandem repeat(VNTR) polymorphism of endothelial nitric oxide synthase(eNOS) gene and cerebral infarction(CI).Methods The genotypes of 152 patients with CI were detected by polymerase chain reaction(PCR) and compared with control group. Multiple regression analysis was performed to assess the independent roles of the polymorphism of eNOS and other risk factors.Results The ab genotype distribution frequency of eNOS gene in CI group(22.36%) was higher than that in control group(12.28%), and a allele frequency of eNOS gene in CI group(12.5%) was also higher than that in control group(7.0%). Both differences between CI group and control group were significant(all P

Artificial liver support system (ALSS),as a means of bridging patients with liver failure to transplantation,has been widely used at home and abroad.However,clinical trails show that different ALSS may have different therapeutic effects.This review briefly introduces the widely-used non-biological liver support technologies and extensively-studied biological liver support technologies,and tries to give an overview on their impact on biochemical markers and survival.

Objective To evaluate extracellular and intracellular IFNγ and IL-4 levels in assessing Th1/Th2 balance in children with chronic hepatitis B (CHB) and asymptomatic carriers.Methods Fiftyfour hospitalized children including 23 CHB patients and 31 asymptomatic carriers were collected from May 2007 to February 2009.Thirty-four healthy children were served as control.Serum IFNγ and IL-4 levels were measured by enzyme-linked immunosorbent assay (ELISA) and intracellular IFNγand IL-4 levels were detected by flow cytometer.Analysis of variance (for homogenous variance) and Kruskal-Wallis test (for non-homogenous variance) were performed.Results The differences on extracellular IFNγ, IL-4 and Th1/Th2 among CHB, asymptomatic carriers and control groups were not statistically significant (F=0.342, 0.020 and 0.507, P ＞ 0.05); while the intracellular IFNγlevels were (7.68 ± 4.62), (11.71 ±4.36) and (13.61 ±6.71) μg/mL, and Th1/Th2 ratios were 0.96 ±0.30, 1.67 ±0.76 and 2.11 ± 1.12in three groups respectively (F=0.255 and 0.140, P ＜ 0.05 or ＜ 0.01).The differences in intracellular IL-4 levels among three groups were not significant (F=0.425, P ＞ 0.05).Conclusions Cytokine balance is affected in CHB children and asymptomatic carriers, and flow cytometry analysis is considered as a better method in evaluating the status of Th1/Th2 balance.

Objective To investigate the role of intestinal immune dysfunction in the pathogenesis of irritable bowel syndrome(IBS) and to study the effects of Clostridium butylicum on the regulation of intestinal immune disorders.Methods A total of 50 male 6-week-old C57BL/6 mice were randomly divided into three groups,including the experimental group (n =20),the control group (n =20) and the Clostridium butylicum group(n =10).A mouse model of constipation-predominant IBS (C-IBS) was established by perfusing sodium butyrate solution(200 μl,concentration of 500 mmol/L) into the mouse colon twice a day for three consecutive days.The mice in control group were intrarectally perfused with normal saline enema (200 μl).Two hours before the perfusion of sodium butyrate into colon,the mice in Clostridium butylicum group were given Clostridium butylicum 500 μl(viable cell concentration of 1×109 CFU/ml) by oral gavage once a day for six days.The colorectal distention test(CRD) was carried out for evaluation of clinical parameters.HE staining of intestinal tissue section was performed for histopathological assessment of colonic mucosal inflammation.Intestinal intraepithelial lymphocytes (IELs) and lamina propria mononuclear cells (LPMCs) were isolated and analyzed by flow cytometry to evaluate the correlation between IBS and intestinal immune dysfunction/abnormal activation of intestinal immune cells in mouse model of C-IBS,and to assess the regulatory effects of Clostridium butylicum on the intestinal immune disorder.Results (1) Compared with the control group,the mice in experimental group showed a significant change in physiological parameters,histological structure of colon,inflammatory cells infiltration and low-grade inflammatory state.There was a significant increase in scores of CRD and a decrease in lowest sensory threshold (t=8.926 and t=6.103,both P＜0.001) ; (2) There was a decrease in the numbers of DC in IELs (t =2.878 and t =3.086,both P＜0.05),but an increase in the numbers of macrophage (t=3.191,P＜0.05) and the memory T cells in mice with IBS (t=3.071,P＜0.05) as compared with that in control group; (3)DCs were decreased (t=2.880 and t=2.664,both P＜0.05),but memory T cells were increased (t =3.732 and 2.682,P＜0.01 and P＜0.05) in the LPMCs of mice in experimental group; (4)There was no significant difference in the physiological index between the mice in control group and the Clostridium butylicum group.Levels of memory T cells,macrophages and DCs in the IELs were close to the normal level (6 d,t =1.103,0.0213,0.418,all P＞0.05),and levels of macrophages and DCs in the LPMCs of mice in the Clostridium butylicum group were also similar to that in the control group (6 d,t =0.782,0.347,both P＞0.05) ; (5) Compared with the mice in experimental group,the level of memory T cells in LPMCs of mice treated with Clostridium butylicum was dramatically declined (6 d,t=2.346,P=0.0470,P＜0.05),however,which was still higher than that of mice in control group (6 d,t =2.233,P =0.0476,P＜0.05).The intestinal immune function was restored to normal level with Clostridium butylicum intervention.Conclusion The pathophysiologic mechanism of IBS might be closely related to the abnormal activation of intestinal immune cellsand disordered functional state in the intestinal mucosa.Clostridium butylicum could regulate the intestinal immune homeostasis and restore the physiological function of gastrointestinal tract.

Objective:To evaluate the clinical features and follow-up effect of treatment for retinal capillary hemangioma (RCH) of myopic disc.Methods:Retrospective case series studies. A total of 14 patients (15 eyes) diagnosed with juxtapapillary RCH (JRCH) at Peking Union Medical College Hospital and followed up for more than 12 months from January 2007 to December 2019 were included. Among these patients, there were 7 males (7 eyes) and 7 females (8 eyes) with the average age of 29.8±12.7 years. There were 6 isolated JRCH cases, all of which were monocular patients, including 1 case with a single peripheral RCH; 8 cases with von Hippel-Lindau disease, including 5 cases of binocular RCH. Out of 15 eyes, 6 eyes were merged with peripheral RCH. Three eyes were simply observed, and 12 eyes were treated with photodynamic therapy (PDT) alone or PDT combined with other treatments. The average follow-up time was 55.2 months. Its clinical characteristics and long-term treatment effects were analyzed.Results:At the first visit, among the 15 eyes, 3 eyes had visual acuity <0.1, 5 eyes were 0.1-0.4, and 7 eyes were> 0.5. The endogenous and fixed exogenous JRCH were 12 (80%, 12/15) and 3 (20%, 3/15) eyes, respectively. The size of the tumor was 1/4 to 4 optic disc diameters (DD); the combined macular edema, epiretinal membrane, and macular hole were 11, 5, and 1 eyes, respectively. There were 3 eyes with tumor diameter less than 1 DD. The visual acuity at the first diagnosis was 0.6-1.0, and no treatment was given. The follow-up time was 12 months in 2 eyes and 120 months in 1 eye. At the last follow-up, his vision remained stable and the tumor did not enlarge. Six eyes with tumor diameter ranging from 1.0 to 2.5 DD, visual acuity was 0.06 to 0.6 at first diagnosis, accompanied by retinal exudation. 5 eyes were treated with PDT alone, and 1 eye was treated with PDT combined with anti-vascular endothelial growth factor drugs. The follow-up time was 12 to 84 months. At the last follow-up, the visual acuity improved or stabilized in 5 eyes and decreased in 1 eye. There were 6 eyes with peripheral RCH, including 4 eyes with retinal detachment, 2 eyes with epiretinal membrane, and 1 eye with vitreous hemorrhage. The visual acuity at the first visit was 0.02-0.6. All patients were treated with PDT combined with transpupillary thermotherapy, extrascleral drainage, and vitrectomy. The follow-up time was 12 to 132 months. At the last follow-up, all eyesight decreased.Conclusions:Visual decrease cause by JRCH often occurs at young adults. Bilateral JRCH are more common in patients with von Hippel-Lindau's disease. The tumor can cause retinal exudation, macular edema, epiretinal membrane and macular hole, resulting in gradual vision loss. PDT and/or combined anti-vascular endothelial growth factor drugs for medium sized JRCH with retinal exudation can maintain long-term vision stability. Patients with large JRCH or severe complications such as retinal detachment tend to have poor prognosis.