Objective To evaluate the classification and treatment methods of hand degloving in-juries.Methods Individualized treatment was adopted according to area and depth of degloving inju-ries.The injury was repaired from deep to shallow layer.New techniques such as segment blood vessel re-pair, alternative debridement, local fixation and suturing, local pressure bandaging and sporadic drainageof incision were applied.Results All 76 patients were followed up for 3-48 months, which showed that75 patients were cured, with good shapes of the skins and strong rub resistance.Conclusion Classifi-cation of hand degloving injuries simplifies diagnosis, as facilitates the individulized treatment.Five new techniques mentioned above may help solve the problems encountered during operation.Individulized treatment explores new ways for the treatment of hand degloving injuries.

Objective To investigate the effects of sodium aescinate(SA)on oxidative stress and pulmonary function during acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods One hundred and twenty patients with COPD were randomly divided into two groups:the control group(n =60) and the treatment group(n =60).All patients were treated with routine anti-infection,oxygen inhalation,relieving phlegm and anti-asthma The treatment group took SA in addition to the routine beteropathy.The changes of serum SOD,MDA,GSH-Px,T-AOC,pulmonary functions and 6 minute walk distance(6MWD) were detected before and after two-week treatment in patients of the two groups to compare with 60 healthy subjects.Results The total effective rate in the treatment group was 91.67％,while 76.67％ in the control group.The difference was statistically significant(x2 =5.065,P ＜0.05).Serum MDA level in both groups were comparatively higher than the healthy controls(9.25±1.55) μmol/L vs.(9.74±1.50) μmol/L vs.(2.06±0.29) μmol/L,P ＜0.001),while the levels of SOD,GSH-Px and T-AOC were lower than the healthy controls[SOD:(91.14±9.54) kU/L vs.(90.61±8.01) kU/L vs.(116.63±6.57) kU/L; GSH-Px:(139.38±36.56) U vs.(137.57±34.19) U/L vs.(189.34±35.54) U/L; T-AOC:(6.48±1.15) kU/L vs.(6.39±1.13) kU/L vs.(13.34±1.23)kU/L;P < 0.001].After treatment,all indexes of the two groups were obviously ameliorated in comparison with before treatment(P ＜ 0.001),but the level of MDA[(4.56±1.39) μmol/L]in the treatment group decreased more greatly than in the control groups(P ＜ 0.001).The levels of SOD[(103.85±7.07) kU/L],GSH-Px[(169.65±34.51) U/L],T-AOC[(10.52±1.09) KU/L],forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC)[(60.49±6.11)％],FEVI％[(76.62±6.35)％]and 6MWD [(394.83±10.11)m]increased considerably more than those in the control group(P ＜ 0.001).Conclusion Oxidative stress might be involved in the course of acute exacerbation of COPD.Sodium aeseinate can improve the pulmonary functions by ameliorating the oxidative stress during acute exacerbation in patients with COPD.

Objective To investigate the nursing of replantation methods of sea-water soaked rotated avulsion amputated fingers.Methods There were 8 cases (16 fingers) with sea-water soaked rotated avulsion amputated fingers.5 cases were replanted by synchronic replantation method,the other 3 cases were replanted by traditional replantation method.We adopted complete debridement and high quality vascular anastomosis during the operation,and give hyperbaric oxygen therapy and anticoagulant treatment post-operation.Results There were 15 survival fingers in 16 replanted fingers.The survival rate was 93.75％.After follow-up for three months to two years,the total good rate was 87.5％.No wound infection and nonunion of fracture occurred.The outline of the fingers was satisfying and patients felt well.The twopoint discrimination was 3～6 mm after 3～24 months follow-up.Conclusions The injury of sea-water soaked rotated avulsion amputated fingers is complicated and the replantation operation is difficult.but if we can adopt individual measure according to the actual circumstance,it is possible that the sea-water soaked rotated avulsion amputated fingers can survive.

Objective To summarize the clinical experiences in microsurgical treatment of severe children hand injuries caused by firecrackers. Methods 26 cases of children hand injuries caused by a firecracker blast were treated with microsurgical procedures. An emergency operation was done for 23 cases, and a delayed repair was done for 3 cases. Operative procedures differed from case to case, according to the injury type. Results All flaps and reconstructed thumbs survived completely by first intention. Of the 9 cases with 11 fingers replanted, 7cases with 9 fingers survived. The follow up for over two years showed that satisfactory restoration of hand function and shape was achieved and the replanted fingers also showed satisfactory restoration of holding and finger to palm and finger to finger functions. Conclusion Severe children hand injuries caused by a firecracker blast must be treated as soon as possible with microsurgical procedures. Preoperative planning of a proper repair or reconstruction approach is also of great importance.

Objective To summarize the clinical characteristics of autoimmune pancreatitis (AIP) and discuss the role and significance of surgical intervention in the treatment of AIP.Methods The clinical data of 11 patients with preoperative confirmed AIP and 8 patients with preoperative suspected AIP receiving surgical intervention at the First Affiliated Hospital of Harbin Medical University from 2011 to 2017 were retrospectively analyzed.Results Among 11 preoperatively confirmed AIP patients,9 (47.4％) underwent endoscopic retrograde cholangiopancreatography (ERCP) with nasal bile duct implantation or biliary stent drainage,and 2 (10.5％)underwent choledochojejunostomy.Among 8 putative AIP patients in which a cancer was suspected 4 (21.1％) underwent choledochojejunostomy,3 (15.8％) did pancreaticoduodenectomy,and 1 (5.3％) had distal pancreatectomy plus splenectomy.Postoperative pathology confirmed pancreatic cancer in 3 cases,IPMN in 1 case.Conclusions While autoimmune pancreatitis is IgG4 related disease,surgical intervention is indicated when there is poor response to drug treatment or when a cancer is to be ruled out.