Objective:To explore the efficacy and therapeutic mechanism of immune inhibitor tacrolimus(FK506) for experimental autoimmune encephalomyelitis rats and compare the efficacy of FK506 and confirmed traditional methyllprednisolone.Methods:the guinea pig spinal cord homogenate in complete freund's adjuvant was used to induce the acute EAE in SD rats FK506 at the dosage of 1 mg/kg and 0.5 mg/kg were intraperitoneally injected to EAE rats respetively for daily for ten days.Clinical features were observed,their peripheral blood lymphocytes CD3,CD4,CD8 and NK subsets were counted,pathology changes of brain and spinal cord were observed,and the evidence of nerve regeneration was shown by immunohistochemistry stain.Result:FK506 could relieve remits the clinical phenonoue of EAE promote the climical and release and recoveny of EAE,decrease the inflammatory infiltration in the CNS,decrease demyelination and axonal damage in CNS,promote for axons regeneration.Furthermore,no replase after stopping drug was observed.Conclusion:FK506 as a immune inhibitor can be used the Autoimmune disease,such as EAE.

Objective To evaluate the recent safety and long-term curative effect of double-pool shaping trabeculectomy with adjustable sutures in glaucoma. Methods A hundred and twenty patients with glaucoma were randomly divided into two groups, in which the control group in 62 patients underwent traditional trabeculectomy and the experimental group in 58 patients underwent double-pool shaping trabeculectomy with adjustable sutures. All patients were followed up for one year. Postoprative intraocular pressure, anterior chamber depth and filtering bleb were observed. Results In the experimental group, after the demolition of adjustable sutures, 3 eyes(5.17%) suffered from I degree shallow anterior chamber. By contrast, 8 eyes suffered from I degree shallow anterior chamber, and 1 eye (total 14.52%) suffered from Ⅱ degree shallow anterior chamber in the control group (P < 0.05). Following up in one year, the functional filtering bleb and intraocular pressure got better in the experimental group than in the control group (P < 0.05). Conclusion Double-pool shaping trabeculectomy with adjustable sutures is a safe and feasible method for glaucoma, in which it can effectively reduce intraocular pressure without complications.

The iatrogenic splenic injuries occurred in 49 patients who underwent abdominal surgery from January 2005 to January 2020; including grade I injury in 40 cases and grade Ⅱ injury in 9 patients. The normal saline-soaked gauze was placed on the wound surface of the injured spleen, then the high-frequency electric coagulator was employed for hemostasis. The bleeding was successfully stopped and the spleens were preserved without postoperative complications in all cases. The results show that moist electrothermal coagulation can be effectively and safely applied in treatment of grade I and grade Ⅱ injury iatrogenic splenic injuries, and no special equipment required.

A total of 521 patients underwent laparoscopic radical gastrectomy from January 2013 to January 2020 in the First People′s Hospital of Wenling. In 242 cases the splenomental fold was severed before dissecting the left half of omentum or spleen (pretreatment group), and in 279 cases the splenomental fold was not severed priorly (routine group). For pretreatment group the introoperative splenic injury occurred in 4 cases (1.65%), including 3 cases (1.24%) with class Ⅰ injury and 1 case (0.41%) with class Ⅱ injury; while for routine group splenic injury occurred in 24 cases (8.60%), including 22 cases (7.89%) with class Ⅰ injury and 2 cases (0.72%) with class Ⅱ injury, and the rupture of splenic capsule caused by tracting splenomental fold occurred in 19 cases(6.81%). There were significant differences in total number of splenic injuries, splenic injuries with class Ⅰ and rupture of splenic capsule caused by tracting splenomental fold between two groups ( P<0.05). The operation time of 28 cases with splenic injuries was (185±89) min, which was longer than that in 493 cases without splenic injuries [(172±95) min, P<0.05]. The results show that rupture of splenic capsule by tracting splenomental fold is main cause of splenic injury in laparoscopic radical gastrectomy and most of them are class Ⅰ injuries. To sever the splenomental fold priorly can reduce the incidence of iatrogenic splenic injury.

The MRI appearances of 7 adult patients with pathologically proven intracranial primitive neuroectodermal tumors (PNET) were retrospectively analyzed. The MRI features were compared with findings in pathology and surgery. In this group, the tumor masses were most commonly found in the semisphere of cerebrum and in the vermis of cerebellum. They were relatively large and 4 were in lobulated shape. All of them had well-defined margins. MR images showed the tumors to be mildly or obviously hypointense on T1-weighted images and hyperintense on T2-weighted images. Most masses had heterogeneous appearances with some cystic and necrotic areas. Intratumoral haemorrhage and focal calcification were occasionally seen. Mostly, there was no or only mild surrounding edema. Marked inhomogeneous contrast enhancement on MRI was seen in 6 cases except one. Two patients with multiple intracranial metastases were revealed on MR images. In this series, there was good correlation between MRI features and findings in pathology and surgery. These results showed that certain MRI features might suggest the diagnosis of intracranial PNET in adults. MRI is an effective technique to detect these tumors and is helpful to treatment planning and follow-up.
Brain Neoplasms/*diagnosis ; Brain Neoplasms/*pathology ; *Magnetic Resonance Imaging ; Neuroectodermal Tumors, Primitive/*diagnosis ; Neuroectodermal Tumors, Primitive/*pathology ; Retrospective Studies

Objective To explore the surgical technique and analyze the clinical efficacy of tubular stomach reconstruction via the posterior mediastinal approach after Iovr-Lewis radical resection of esophageal cancer.Methods The clinical data of 63 patients with middle-lower esophageal cancer who were admitted to the First People's Hospital of Chengdu between April 2013 and April 2015 were retrospectively analyzed.All the patients underwent Iovr-Lewis radical resection of esophageal cancer and tubular stomach reconstruction via the posterior mediastinal approach.Video-assisted minithoracotomy (VAMT) was used for anastomosis of esophagus-gastric tube at the top of thorax after laparoscopic abdominal surgery, and then tubular stomach reconstruction via the posterior mediastinal approach was performed by placing gastric tube in the esophageal bed and closing the posterior mediastinal pleura.Patients received regular perioperative treatment.Intraoperative record included operation time, volume of blood loss, volume of blood transfusion and lymph nodes dissection.Postoperative anastomotic leakage was detected by observing thoracic drainage, symptoms of fever, chest pain and elevated hemogram, recovery of intestinal function and closed thoracic drainage-tube removal time.Follow-up was performed by telephone interview and outpatient examination up to April 2015, including with or without normal food intake, gastroesophageal reflux and tumor progression.Results All the patients underwent successful IovrLewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach without perioperative death and intraoperative blood transfusion.The average operation time, average volume of intraoperative blood loss and average number of lymph nodes dissected were 230 minutes, 300 mL and 16, respectively.Patients received gastric tube removal at postoperative day 2 with a good condition of tubular stomach by CT examination.The average time of postoperative gastrointestinal tract recovery was 3 days.Patients took fluid diet at postoperative day 3-4, soft diet at postoperative day 7 and regular diet at postoperative day 10-12.Two patients complicated with slight pulmonary infection were cured by conventional treatment.The closed thoracic drainage-tube removal time was 4 days.All the patients were followed up for a median time of 8 months (range,1-24 months) with regular diet intake and without perioperative death, tumor recurrence, severe gastroesophageal reflux and other complications.Conclusions Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach is safe and feasible, with the advantages of preventing the esophageal anastomotic fistula, reducing postoperative pulmonary infection and promoting early diet intake and enhancing postoperative recovery of patients.

Objective To evaluate the clinical effect of emergency pelvic external fixation in hemodynamically unstable patients with pelvic fracture.Methods The clinical data of 56 hemodynamically unstable patients with pelvic fracture from January 2008 to December 2013 were selected.The changes of hemoglobin,mean arterial pressure,heart rate,serum lactate,urine volume,norepinephrine dosage before and after surgery for 24 h were compared and analyzed.Results Compared with those before surgery,the levels of hemoglobin,mean arterial pressure,serum lactate,urine volume,heart rate after surgery for 24 h were significantly improved:(109 ± 12) g/L vs.(69 ±22) g/L,(87.8 ±6.5) mmHg (1 mmHg =0.133 kPa) vs.(55.8 ± 7.7) mmHg,(6.3 ± 5.1) mmol/L vs.(10.8 ± 6.6) mmol/L,(35.9 ± 9.9) ml/h vs.(17.6 ± 8.4) ml/h,(84.2 ± 15.4) times/min vs.(146.4 ± 12.1) times/min,and the norepinephrine dosage was significantly reduced:(0.8 ± 0.2) μ g/ (kg· min) vs.(2.2 ± 0.8) μ g/ (kg· min).The differences had statistical significance (P ＜ 0.05 or ＜ 0.01).Conclusion Bedside pelvic external fixation can rapidly improve shock symptom in hemodynamically unstable patients with pelvic fracture,which is safe and efficient.

Objective To evaluate the effects of hypothermic cardiopulmonary bypass (CPB) on rocuronium-induced neuromuscular blockade in the patients undergoing open heart surgery.Methods Twenty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective open heart surgery,aged 18-45 yr,with body mass index of 18-25 kg/m2,were randomly assigned into 2 groups (n =10 each) using a random number table:room temperature group (group R) and hypothermia group (group H).The nasopharyngeal temperature was maintained at 30-31 ℃ during CPB in group H or at 36-37 ℃ during CPB in group R,and it was maintained at 36-37 ℃ before and after CPB in both groups.Anesthesia was induced with iv etomidate 0.3 mg/kg,fentanyl 2-4 μg/kg and rocuronium 0.3 mg/kg.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of sufentanil and intermittent iv boluses of midazolam and fentanyl.BIS value was maintained at 40-60.Neuromuscular block was monitored using TOF-WATCH SX accelerometer.Train-of-four stimulation (intensity 40 mA,frequency 2 Hz,wave length 0.2 ms,interval 12 s) of ulnar nerve was used.Rocuronium was infused intravenously using an automatic feedback control system to maintain T1 at 8％-12％.At 10 min after start of operation (T0),10 min after onset of CPB (T1),and 10 min after termination of CPB,blood samples were collected for determination of the plasma concentration of rocuronium (by HPLC).The infusion rate and consumption of rocuronium were recorded before,during and after CPB.Results Compared with group R,the plasma concentration of rocuronium was significantly decreased at T1,2,and the infusion rate and consumption of rocuronium were decreased before and after CPB in group H.Conclusion Hypothermic CPB enhances rocuroniuminduced neuromuscular blockade in the patients undergoing open heart surgery.

Objective To investigate the relationship between the quality of life and different frequency of sudden death in Yunnan unexplained sudden death disease area.Methods According to the stratified cluster sampling method,728 individuals were selected as the respondents in Heqing County,Eryuan County of Dali Bai Autonomous Prefecture,and in Dayao County of Chuxiong Yi Autonomous Prefecture.According to the random sampling,649 individuals were selected as the control in Yongping County,Dali Bai Autonomous Prefecture.Data of the quality of life (WHOQOL-BREF version) were collected through household surveys.Analysis method including ANOVA,Chi-squared test and multilinear regression were used.Results Compared with the control population,the household income of population in the diseased area was not significantly different statistically (x2 =7.052,P ＞ 0.05).But the differences in education level and chronic disease situation were statistically significant (x2 =35.727,9.810,all P ＜ 0.05).According to the frequency of the sudden death,from one to four,the total scores of the quality of life,the scores of the physiology domain,the scores of the psychological domain,the scores of the environmental domain and the scores of the social relations domain (1 time:54.30,13.74,14.43,11.21,14.91;2 times:54.75,13.86,14.65,11.12,15.10;3 times:52.40,13.21,13.76,11.00,14.41;4 times:49.21,12.15,12.54,9.87,14.64)were all lower than those of the control group (56.03,14.11,14.78,11.88 and 15.26),the differences between two groups were statistically significant (x2 =41.88,25.75,41.07,35.07,8.08,all P ＜ 0.05);the total scores and each domain score of the quality of life were negatively correlated with the frequency of sudden death (the multi-variables regression coefficient were as follows:-1.195,-0.341,-0.356,-0.314,and-0.185,all P ＜ 0.05).Conclusions The quality of life of those who have lived in Yunnan unexplained sudden death area is associated with the outbreak frequency of sudden death.Following increasing of the outbreak frequency of Yunnan unexplained sudden death,the quality of life of the population living in Yunnan unexplained sudden death area has decreased.

Objective To approach the design and clinical application of large anterolateral thigh flap and its effect in wound repair.Methods The flaps were designed according to the anatomical features of perforating branches in the anterolateral thigh flaps.When a flap was chipped,a thick branch or a terminal branch of original vessel was reserved,another suitable perforating branch was selected in the proximal or distal end of the flap,and then the two vessels were anastomosed to enlarge the range of blood supply.If the vessel pedicle of a flap was a musculocutaneous perforating branch,the perforating branch of anastomosis was cut at out-point of muscle.If the vessel pedicle of a flap was a intermusclar branch or a direct skin artery,the perforating branch of anastomosis was cut widely.From May 2006 to May 2012,the technique was applied in 28 patients with large skin defect of limbs.The diameters of perforating branches obtained at out-point of muscles were measured during surgery.The survival of flaps was observed after surgery and complications in donor sites were checked during follow-ups.Results There were 18 flaps whose vessel pedicle were musculocutaneous perforating branches.The branches were cut at outpoint of muscles.The diameters of these vessels were measured during surgery.They ranged from 1.3 mm to 1.8 mm with an average of 1.45 mm.All of the vessels could be anastomosed.All 28 flaps survived.All flaps survived.The areas of the flaps ranged from 22 cm × 15 cm to 42 cm × 14 cm.Artery crisis happened in 2 flaps whose vessel pedicle were musculocutaneous perforating branches.The second look operation found that the areas of artery anastomosis of perforating branches and vessel pedicles were compressed by hematoma and thrombus formed.The 2 flaps survived after the hematoma was cleared away and the vessels were reanastomosed.There were no infections.Both the donor and recipient site healed by first intention with no necrosis of flap margin.All 28 patients were followed up by 4-13 months with an average of 8 months.There were no apparent collapse deformities,muscle necrosis,declines of muscle strength and muscle hernia in the donor sites.The appearance of flaps was flat,the color was close to normal and the quality was fine.Conclusion It is a safe and effective method to repair wound surface by large anaterolateral thigh flap obtained by the modus operandi of perforating branch anastomosis.