Objective To investigate the first pathogenetie feature and the reason of misdiagnosis about the multiple sclerosis(MS). Methods To review and analyze 62 eases with the first pathogenetic medical record of MS. Results The most frequent clinical manifestation pf the first pathogenetie MS are the limbs paraesthesia(18 eases, 29.0%) ,dyskinesia(16 cases,25.8%) and visual disorder(11 cases, 17.7%), and the other clinical manifestation are the ataxia, epileptic seizure ,dyasarthria, dysuria, itch of skin, mental anomaly, vertigo and so on. The total of misdi-agnosis is 24 cases (38.7 %). Conclusion Except the main clinical manifestation, there are diversity, complexity forfirst pathogenetic MS,what's more the misdiagnosis rate is very high.

Objective To study the curative effect of cerebrospinal fluid replacement combining intravenous drips and intrathecal injection of amphotericin B in the treatment of cryptococcal neoformans meningitis(CNM for short).Methods 28 CNM patients were randomly divided into two groups.Group A was the treatment group,and the treatment method was cerebrospinal fluid replacement combining intravenous drips and intrathecal injection of amphotericin B.Group B was the control group,and the treatment method was only intravenous drips and intrathecal injection of arnphotericin B.The period of treatment was 16 weeks.The curative effect was assessed in terms of symptoms,physical features,CSF routine examination,CSF cultivation and smear examination.Results The cura- tive effect of treatment group was better than that of the control group.There were remarkable differences between these two groups(P

12,9.41%(148/1578);RDQ≤12,91.58%(1430/1578).Logistic multiple regression analysis of gastroesophageal reflux correlation factor studied:OR= 2.781.Conclusions The results showed:there were close correlation of high salt diet and GERED.

Objective: To study the protective effect of compound extract of soybean, wolfberry and hawthorn on chemical liver injury in mice respectively. Methods:The mice were randomly divided into 5 groups:control(A), liver injury control(B)and 0.06(C)?0.20(D)?0.60(E) g/(kg?bw) compound extract group. The liver injury models were induced by CCl 4 and ethanol in mice respectively. After 4 weeks, for the former, the serum ALT and AST content were measured and the liver pathological change was observed. For the latter, the liver MDA, GSH, and TG content were measured and fat droplets staining in the ice pathological slice were observed . Results: 1.CCl 4 liver injury models:the content of serum ALT of group D and the AST of group D and E were decreased. Compared with normal group, the hepatic pathological changes of the compound extract group was mainly fatty and ballon degeneration, and that of the CCl 4 group was mainly hepatic cytoclasis. 2.Ethanol liver injury models: the content of liver MDA of group C, E and the TG of group C, D, E were all decreased, and the fatty degeneration scores of group C, D were lower, both compared with ethanol group. Conclusion: Compound extract of soybean, wolfberry and hawthorn has the protective effect on liver injuries induced by both CCl 4 and ethanol in mice.

Objective:To evaluate the influence of minimally invasive corticotomy on the treatment time and molar anchorage of adult orthodontic extraction cases.Methods:60 adult cases of Angle Class Ⅰ crowding malocclusion were devided into 3 groups (n =20) and treated by orthodontic treatment wtih minimally invasive corticotomy(group A),orthodontic treatment with classic modified corticotomy(group B) and routine orthodontic treatment (group C) respectively.Time needed for leveling and alignment,space closure,delicate adjustment,total treatment time and mesial sagittal antedisplacement of first molar anchorage were compared among the 3 groups.Results:Time needed for leveling and alignment of orthodontic treatment of group A,B and C was (5.64 ± 2.57),(4.91 ± 3.31) and (8.87 ± 3.75) months respectively(C vs A or B,P ＜ 0.01).Time needed for space closure of group A,B and C was (6.84 ± 2.69),(6.64 ± 3.87) and (8.63 ± 3.29) months respectively(C vs A or B,P ＜0.01).Time needed for delicate adjustment showed no significant difference among the 3 groups(P ＞ 0.05).Total treatment time of group A,B and C was (16.07 ± 6.21),(15.77 ± 5.11)and (21.94 ± 5.74) months respectively (C vs A or B,P ＜ 0.01).There was on statistical difference of mesial sagittal antedisplacement of first molar anchorage among the 3 groups.Conclusion:Minimally invasive corticotomy can shorten the orthodontic treatment time,but can not decrease the retraction resistance of the anterior teeth.

Objective:To study the indications and clinical efficacy of video assisted small incision in treatment of infected pancreatic necrosis.Methods:A retrospective study was conducted on 27 patients with infected pancreatic necrosis treated by video assisted small incision at the Department of Pancreatic and Splenic Surgery, Hunan Provincial People's Hospital, from January 2018 to December 2019. The surgical approach, operation time, intraoperative blood loss, postoperative hospital stay and complications were analysed. Postoperative follow-up was carried out at outpatients’ clinic, and the patient's time to full recovery and long-term complications were studied.Results:The 27 patients successfully underwent the operations. There were 22 males and 5 females, aged (50.6±6.2) years. The treatment results were analyzed according to the different surgical approaches: the retroperitoneal approach group ( n=4); the omental sac approach group (n=14); the intercostal space approach group ( n=2); and the combined approach group ( n=7). The operation time was (85.3±31.6)min. The intraoperative blood loss was 65.0(45.2, 121.4)ml. The postoperative hospital stay was 23.0(12.5, 36.1)days. The incidence of complications (Clavien-Dindo grade Ⅲ and above) was 14.8%(4/27). There were 2 patients in this study who were admitted to the intensive care unit due to postoperative hemorrhage: 1 patient responded well to conservative treatment and the remaining patient required interventional treatment. Another patient because of poor results, underwent debridement by laparotomy 2 weeks after the operation. There was 1 patient who developed grade C pancreatic fistula which was cured by surgical treatment 6 months later. On follow-up, 2 patients developed colonic fistula 2 weeks after surgery and 2 patients gastric fistula 1 week and 3 weeks after surgery. These patients responded to conservative treatment. Conclusion:With proper case selection, video assisted small incision could safely and effectively be used to treat infected pancreatic necrosis.

Objective:This work aims determine the expression of the neurotensin (NTS) gene in hepatocellular carcinoma (HCC) subgrouping using immunohistochemical staining (IHC) as well as to evaluate the correlation between the activation of NTS/IL-8 pathway in HCC and inflammatory response in microenvironment and epithelial mesenchymal transition (EMT) in cancer and in the prognosis of patients. Methods:Tumor tissues and corresponding adjacent normal tissue were collected from 64 cases of HCC patients. The expression levels of NTS protein and multiple inflammation and EMT-related proteins, including IL-8, VEGF, MMP9, CD68, E-Cadherin,β-Catenin, and Vimentin, were examined in 64 cases of paraffin-embedded HCC tissues using the immunohistochemistry (IHC) staining method. The clinical outcome and overall survival (OS) among 64 cases of HCC patients were compared. Results:We found that the frequency of NTS-expressing tissues among all HCC samples was 17.19%(11/64). Significantly increased IL-8 protein was confirmed in 90.91%of NTS+HCC samples and was positively correlated with the levels of NTS protein in cancer tissues (P=0.036), which implied the dysfunctional activation of NTS/IL-8 pathway in HCC. The levels of VEGF and MMP9 were significantly correlated with the co-expression of NTS and IL-8 in HCC. Evident features of EMT, including decreased membrane expression of E-Cadherin and increased accumulation of cytoplasmicβ-Catemin and Vimentin, were found in NTS+IL-8+samples. The co-expression of NTS and IL-8 in cancer was significantly correlated with the clinical outcomes of patients, as the mortality rate of NTS+IL-8+HCC patients is 2.5-fold higher than that of others after surgery (P=0.022).Accordingly, the OS of NTS+IL-8+HCC patients significantly decreased (24.65±4.45 m vs. 75.79±16.32 m, P=0.013), and these patients are at a higher risk of death at an expected hazard ratio (HR) of 3.457. Conclusion:The NTS/IL-8 pathway is dysfunctionally activated in a subgroup of HCC samples. Highly expressed NTS is associated with increased inflammatory response in microenvironment, enhanced EMT in cancer, and worse prognosis in HCC patients.

Objective To investigate the risk factors of postoperative hemorrhage after pancreatoduodenectomy (PD).Methods The retrospective case-control study was adopted.The clinical data of 857 patients with pancreatic diseases who were admitted to the First Affiliated Hospital of Hunan Normal University from January 2007 to December 2014 were collected.All the 857 patients underwent PD and digestive tract reconstruction using the Child method.The number of patients with postoperative hemorrhage,classification,bleeding sites,source and time of bleeding and method and effect of treatment after PD were observed.The correlations among the gender,age,concomitant diseases (diabetes and hypertension),malignancy degree of tumor,the preoperative levels of serum alanine transaminase (ALT),total bilirubin (TBil),albumin (Alb) and prothrombin time (PT),international normalized ratio (INR),operation time,volume of intraoperative blood loss,method of pancreatic and jejunal anastomosis and postoperative hemorrhage after PD were analyzed.The follow-up of outpatient examination and telephone interview was performed to observe postoperative recovery of patients for 2 months till February 2015.Univariate analysis and multivariate analysis were done using the chisquare test and Logistic regression model,respectively.Results Of 72 patients with postoperative hemorrhage,grade A,B and C hemorrhage were detected in 3,41 and 28 patients,respectively,and 41,29 and 2 patients had respectively enteral hemorrhage,parenteral hemorrhage and enteral and parenteral hemorrhage.After PD,38 patients had hemorrhage located at the gastrointestinal tract,9 at the common hepatic artery,proper hepatic artery and gastroduodenal artery (5 due to pseudoaneurysm),5 at the pancreatic section,3 at the jejunal mesenteric vessels,2 at the middle colic arterial branches,1 at the superior mesenteric artery,1 at the superior mesenteric vein and 13 at the ambiguous bleeding sites.The early and late stage hemorrhages (within postoperative hour 24 and after postoperative hour 24) were detected in 20 and 52 patients,respectively.Of 44 patients with grade A and B of hemorrhages,17 underwent conservative treatment,16 underwent reoperation,8 underwent hemostatic therapy under gastroscopy,3 underwent interventional treatment.All the 44 patients had good hemostasis effect.Of 28 patients with grade C of hemorrhage,interventional treatment,reoperation,hemostatic therapy under gastroscopy,conservative treatment,interventional treatment + reoperation and gastroscopy + interventional treatment were applied to 10,7,4,3,3 and 1 patients,respectively.Ten of 28 patients died and 18 had successful hemostasis.The gender and preoperative levels of ALT and TBil were related factors affecting postoperative hemorrhage after PD in the univariate analysis (x2 =4.516,7.585,7.209,P ＜ 0.05).Male,preoperative ALT ≥ 172 U/L and preoperative TBil ≥ 159 μmol/L were the independent risk factors affecting postoperative hemorrhage after PD in the multivariate analysis (HR =2.033,1.860,1.872,95％ confidence interval:1.237-3.341,1.135-3.047,1.060-3.307,P ＜ 0.05).Fifty of 62 patients were followed up for a median time of 2 months with a follow-up rate of 80.6％ (50/62),and no rehemorrhage was occurred.Conclusion Male,preoperative ALT≥172 U/L and preoperative TBil≥≥ 159 μmol/L are the independent risk factors affecting postoperative hemorrhage after PD.

Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.

Aim To study pharmacokinetics and bioavailablity of domestic penicillin V dispersion tablet in healthy volunteers. Methods According to the crossover design, each volunteer in two groups was orally given a single dose ( 0.75 g ) of domestic penicillin V dispersion tablet or imported penicillinV tablet alternately and the plasma concentrations were determined by RP HPLC. The pharmacokinetic parameters were obtained by using ATPK program and calculated on the basis of open single compartment model. Results After a single oral dose( 0.75 g ), the t 1/2(ke) was ( 0.75 ? 0.10 ) h and ( 0.70 ? 0.14 ) h ,the c max was( 8.44 ? 2.40 ) mg?L -1 and ( 8.75 ? 3.04 ) mg?L -1 at ( 0.56 ? 0.11 ) h and ( 0.63 ? 0.17 ) h and AUC 0～4 was( 8.44 ? 2.40 ) mg?h?L -1 and ( 8.75 ? 3.04 ) mg?h?L -1 for two formulations, respectively. Relative bioavailability of domestic penicillin V dispersion tablet was ( 90.50 ? 8.84 )%. Conclusion The result shows that the two formulations are bioequivalent.