We designed a locator for puncture under CT examination.Thirty-three patients of both sexesaged 16-76 yr weighing 46-80 kg undergoing bilateral thoracic or lumber sympathetic nerve block under CT examination were enrolled in this study.One side was punctured under the guidance of the locator,while the other side was punctured by conventional technique.The time consumed during puncture,CT scan adjusting time,the deviation of the needle from the targets and the incidence of puncture complications were recorded.The results showed that compared with the conventional technique,with the locator the time consumed during puncture was significantly shorter,the number of attempts and the deviation of the needle from the target were significantly reduced.The procedure was successfully performed on both side in all patients without serious complications such as hemothorax and pneumothorax.

Objective:To explore the clinical curative effect of foot-ankle balance massage combined with herbal fumigation on acute ankle sprain.Methods:According to random number table method, 62 patients with acute ankle sprain meeting the inclusion criteria in the hospital were divided into control group and observation group between January 2018 and January 2021, 31 in each group. The control group was treated with foot-ankle balance massage, while the observation group added herbal fumigation treatment on the basis of the control group treatment. Both were treated for 7 days. The pain degree was evaluated by Visual Analogue Scale (VAS). The pain sites of ankle joint were evaluated by Kofoed ankle scale. The recovery of ankle and foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS). The levels of plasma substance P, neuropeptide, nerve growth factor (NGF), IL-1β, IL-6 and hs-CRP were detected by enzyme-linked immunosorbent assay. The clinical curative effect was assessed.Results:The differences in total response rate between observation group and control group were statistically significant [96.8% (30/31) vs. 77.4% (24/31)] ( χ 2=5.17, P=0.023). At 1st day, 3rd day and 7th day after treatment, VAS scores in observation group were significantly lower than those in the control group ( t=4.86, 5.19, 3.86, P<0.01), Kofoed scores were significantly higher than those in the control group ( t=2.03, 2.58, 2.46, P<0.05), and AOFAS pain scores were significantly higher than those in the control group ( t=2.61, 2.47, 4.90, P<0.05). After treatment, levels of substance P [(2.94±0.91) mg/L vs. (3.69±0.94) mg/L, t=3.19], neuropeptide [(141.06±16.31) ng/L vs. (165.22±17.63) ng/L, t=3.16] and NGF [(43.65±10.15) ng/L vs. (52.26±10.20) ng/L, t=3.33] in observation group were significantly lower than those in the control group ( P<0.01), and levels of IL-1β, IL-6 and hs-CRP were significantly lower than those in the control group ( t=2.60, 2.64, 2.42, P<0.05). Conclusion:The foot-ankle balance massage combined with herbal fumigation can quickly relieve pain, increase levels of pain substances, reduce levels of inflammatory cytokines and improve curative effect in patients with acute ankle sprains.

Objective: To explore the application and clinical efficacy of red blood cell therapeutic apheresis in erythropoietic protoporphyria (EPP) and hereditary hemochromatosis (HH). Methods: 1) The EPP patient was hospitalized twice for "abdominal pain, nausea, vomiting, and brown urine". One and two sessions of red blood cell exchange/therapeutic plasma exchange (RCE/TPE) were respectively performed during the two hospitalizations. During each session, one RCE with 6-8 units of leukoreduced RBCs and 3-4 TPE procedures with 1 800-2 000 mL of frozen plasma was conducted. Biochemical parameters were monitored before and after treatment. 2) The HH patient was hospitalized for “repeatedly elevated aminotransferases”. Erythrocytapheresis was performed once, removing 550 mL of red blood cells, and venous phlebotomy was conducted once every 2 months subsequently. Blood routine and ferritin levels were assessed before and after treatment. Results: 1) During the first hospitalization, the EPP patient was relieved of the abdominal pain and brown urine after therapeutic apheresis. The total bilirubin level decreased from 141.8 μmol/L on admission to 68.6 μmol/L at discharge, with a symptom remission duration of 10 months. During the second hospitalization, the EPP patient still had recurrent abdominal pain after therapeutic apheresis. He developed psychiatric symptoms and gastrointestinal bleeding subsequently, accompanied by elevated bilirubin levels. Liver function deteriorated and the patient went into the state of the end-stage liver disease (ESLD). 2) For the HH patient, the hemoglobin level prior to erythrocytapheresis and vein phlebotomy was 150-160 g/L, with the lowest value occurring two days after erythrocytapheresis, decreasing to 107 g/L. The ferritin level before erythrocytapheresis was 2 428.08 ng/mL and it declined gradually after theraphy, with the lowest value occurring two months after erythrocytapheresis, decreasing to 1 094 ng/mL. The ferritin level was 1 114 ng/mL two months following the first vein phlebotomy, however it increased to 1 472 ng/mL two months after the second vein phlebotomy. Conclusion: RCE/TPE may alleviate protoporphyrin liver disease and help patients with bridging liver transplantation before EPP developments to ESLD. For HH patients with significantly elevated ferritin levels, erythrocytapheresis reduces serum ferritin more quickly and maintains its level longer relative to phlebotomy.

Objective: To explore the application and clinical efficacy of red blood cell therapeutic apheresis in erythropoietic protoporphyria (EPP) and hereditary hemochromatosis (HH). Methods: 1) The EPP patient was hospitalized twice for "abdominal pain, nausea, vomiting, and brown urine". One and two sessions of red blood cell exchange/therapeutic plasma exchange (RCE/TPE) were respectively performed during the two hospitalizations. During each session, one RCE with 6-8 units of leukoreduced RBCs and 3-4 TPE procedures with 1 800-2 000 mL of frozen plasma was conducted. Biochemical parameters were monitored before and after treatment. 2) The HH patient was hospitalized for “repeatedly elevated aminotransferases”. Erythrocytapheresis was performed once, removing 550 mL of red blood cells, and venous phlebotomy was conducted once every 2 months subsequently. Blood routine and ferritin levels were assessed before and after treatment. Results: 1) During the first hospitalization, the EPP patient was relieved of the abdominal pain and brown urine after therapeutic apheresis. The total bilirubin level decreased from 141.8 μmol/L on admission to 68.6 μmol/L at discharge, with a symptom remission duration of 10 months. During the second hospitalization, the EPP patient still had recurrent abdominal pain after therapeutic apheresis. He developed psychiatric symptoms and gastrointestinal bleeding subsequently, accompanied by elevated bilirubin levels. Liver function deteriorated and the patient went into the state of the end-stage liver disease (ESLD). 2) For the HH patient, the hemoglobin level prior to erythrocytapheresis and vein phlebotomy was 150-160 g/L, with the lowest value occurring two days after erythrocytapheresis, decreasing to 107 g/L. The ferritin level before erythrocytapheresis was 2 428.08 ng/mL and it declined gradually after theraphy, with the lowest value occurring two months after erythrocytapheresis, decreasing to 1 094 ng/mL. The ferritin level was 1 114 ng/mL two months following the first vein phlebotomy, however it increased to 1 472 ng/mL two months after the second vein phlebotomy. Conclusion: RCE/TPE may alleviate protoporphyrin liver disease and help patients with bridging liver transplantation before EPP developments to ESLD. For HH patients with significantly elevated ferritin levels, erythrocytapheresis reduces serum ferritin more quickly and maintains its level longer relative to phlebotomy.