Objective:To investigate the influence of bundled ligation of the pancreatic stump on postoperative pancreatic fistula (POPF) of distal pancreatectomy (DP).Methods:The retrospective case-control study was conducted. The clinical data of 60 patients with diseases in pancreatic body and tail who underwent DP in the Affiliated Hospital of Inner Mongolia Medical University from January 2011 to August 2018 were collected. There were 24 males and 36 females, aged from 19 to 68 years, with a median age of 45 years. Of the 60 patients, 36 cases undergoing dissection of pancreas with Endo-GIA stapler were allocated into non-bundled group, and 24 cases undergoing bundled ligation of the pancreatic stump with No.10 or No.7 suture at the site over 1 cm of the resection site before dissection of pancreas were allocated into bundled group. Observation indicators: (1) postoperative situations; (2) analysis of risk factors for POPF of DP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test or ANOVA test. Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test and multivariate analysis was conducted using the Logistic regression model. Results:(1) Postoperative situations: the amylase concentration, cases with biochemical fistula, cases with grade B pancreatic fistula, cases with complications, time to extubation, duration of postoperative hospital stay, total hospital expenses were (2 629±592)U/L, 14, 5, 7, (11.9±0.7)days, (13.6±0.7)days, (49 430±1 626)yuan in non-bundled group and (683±312)U/L, 3, 1, 2, (9.7±0.6)days, (11.3±0.5)days, (44 767±1 163)yuan in bundled group, respectively. There were significant differences in the amylase concentration, cases with biochemical fistula, time to extubation, duration of hospital stay, total hospital expenses between the two groups ( t=2.528, χ2=1.512, t=2.341, 2.311, 2.111, P<0.05), and there was no significant difference in the cases with grade B pancreatic fistula or cases with complications between the two groups ( χ2=1.512, 1.394, P>0.05). (2) Analysis of risk factors for POPF of DP. Results of univariate analysis showed that tumor diameter and bundled ligation of the pancreatic stump were related factors of patients undergoing pancreatic fistula after DP ( χ2=4.462, 5.061, P<0.05). Results of multivariate analysis showed that bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP ( odds ratio=0.187, 95% confidence interval as 0.037-0.954, P<0.05). Conclusions:Bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP. Bundled ligation of the pancreatic stump can effectively reduce the incidence of POPF, especially biochemical fistula, the time to extubation, duration of postoperative hospital stay and total hospital expenses, and promote patient recovery after DP.

Objective To observe the choroidal vascularity index (CVI) and the subfoveal choroidal thickness (SFCT) of central serous chorioretinopathy (CSC),and to compare the stability and consistency of the two methods of measurement.Methods A retrospective study.Thirty-one patients with unilateral acute CSC who visited the Department of Ophthalmology of Beijing Friendship Hospital for the first time during the period from Nov 1st,2016 to Mar 18th,2018 were included in the study.Thirty-one healthy age-matched subjects were enrolled as controls.All CSC affected eyes and their fellow eyes and healthy eyes were scanned by single-line enhanced depth imaging of OCT through central fovea of macula to measure their SFCT.The image was binarized and then the CVI of a 1500 μm range below fovea was calculated,i.e.the ratio of vascular (or lumen) area to total choroidal area.CVI and SFCT were compared among CSC eyes,fellow eyes and healthy eyes by variance analysis.Intra-group correlation coefficient (ICC),Bland-Altman curve and coefficient of variation (CV) were used to analyze the repeatability,consistency and stability of CVI and SFCT;and Medcalc18.2.1 software was used to draw the Bland-Altman curve and observe the consistency of the two measurement methods.Results There were statistically significant differences in CVI and SFCT between CSC affected eyes and fellow eyes (t=3.470,2.844;P=0.001,0.006),CSC affected eyes and healthy eyes (t=6.977,6.277;P＜0.001,＜0.001),fellow eyes and healthy eyes (t=3.508,3.433;P=0.001,0.001).Relative consistency analysis of CVI and SFCT showed that the ICC of single measurement and average measurement of CVI were 0.967 and 0.983 respectively,and that of single measurement and average measurement of SFCT were 0.937 and 0.967 respectively.The consistency of CVI and of SFCT was very good.The ICC value of CVI was slightly higher than that of SFCT.The results of repeatability analysis of CVI and SFCT showed that the difference between the two CVI measurements was smaller,and the difference between the two SFCT measurements was larger.And CVI and SFCT stability analysis results showed that the CV of CVI and SFCT were 10.5％ and 25.3％ respectively.CVI has smaller CV than SFCT.Conclusions Compared with healthy eyes,CVI and SFCT are increased in CSC affected eyes and fellow eyes.And compared with SFCT,CVI has better consistency,repeatability and stability.

Objective To investigate the changes of expression levels of interleukin?17(IL?17) and interleukin?21( IL?21) secreted by helper T cells 17 before and after treatment of three immune?related hematological diseases,and to explore the clinical significance??Methods Sixty patients with IRH admitted to the Department of Hematology,the First Affiliated Hospital of Hebei North University from May 2017 to October 2018 were selected as subjects??They were divided into aplastic anemia group (24 cases),immune thrombocytopenia group (20 cases) and autoimmune hemolytic anemia group (16 cases)??Another 60 healthy volunteers who had physical examination in our hospital at the same time were selected as the control group??In the 3 IRH groups,patients were treated with glucocorticoids or immunologic agents,and the control group was given vitamin C??At the time of initial diagnosis,2 weeks and 3 months after IRH treatment,all the patients in the 4 groups were examined for blood?related indicators,and the therapeutic effects of different stages and the plasma levels of IL?17 and IL?21 in the peripheral blood of the 4 groups before and after treatment were compared??Results At the initial diagnosis,the plasma IL?17 levels in the aplastic anemia group,immune thrombocytopenia group and autoimmune hemolytic anemia group were ((196??52± 17??46), (185??69± 18??19),(126??13 ± 11??22) ng／L),respectively,which were higher than those in control group ((72??36± 10??21) ng／L), the differences were statistically significant ( all P＜0??05)??The plasma IL?21 levels in the aplastic anemia group,immune thrombocytopenia group and autoimmune hemolytic anemia group were ((136??82±20??16),(145??92±22??18),(119??66±12??69)) ng／L,respectively,which were higher than those in control group (( 84??01 ± 9??87) ng／L), and the differences were statistically significant ( all P＜0??05)??After 2 weekly treatment,the levels of IL?17 and IL?21 in the 3 groups were significantly lower than those at the first visit (all P＜0??05)??After 3 months of treatment,the levels of IL?17 and IL?21 in the 3 groups were also significantly lower than those at the first diagnosis ( IL?17: aplastic anemia group ( 84??69 ±12??15) ng／L,immune thrombocytopenia group (90??56±11??64) ng／L,autoimmune hemolytic anemia group (62??83±5??68) ng／L;IL?21: aplastic anemia group ( 96??28± 8??84) ng／L,immunological thrombocytopenia group (103??21±10??62) ng／L,autoimmune hemolytic anemia group (78??64±9??68) g／L),and the difference were statistically significant ( all P＜0??05)??There was no significant change in the control group ( 83??84 ±9??95) ng／L(P＞0??05)??After 3 months of treatment,the total effective rates of treatment in the three groups (the aplastic anemia group 83??33%( 20／24), immunological thrombocytopenia group90??00%( 18／20), autoimmune hemolytic anemia group 75??00%( 12／16)) were higher than 2 weekly treatment ( aplastic anemia group 41??67%( 10／24 ), immunological thrombocytopenia group 40??00%( 8／20 ), autoimmune hemolytic anemia group25??00%(4／16)),and the differences were statistically significant( all P ＜0??05)??Conclusion The changes of plasma IL?17 and IL?21 levels are helpful to indicate the occurrence and progression of immune?related hematopathy,to find therapeutic targets and to improve prognosis,which has important clinical significance in the clinical diagnosis,prognosis and treatment of different types of IRH??

Objective To investigate the expressions of neurite outgrowth inhibitor (Nogo),myelin-associated glycoprotein (MAG) and Nogo receptor-1 (NgR1),and neuro-protective effect of N-Butylphthalide (NBP) in rat brain tissues following acute CO poisoning.Methods Sixty Sprague-Dawley rats were randomly divided into normal group,CO poisoning group and NBP treatment group (n=20).Rats in CO poisoning group and NBP treatment group were induced acute CO poisoning in hyperbaric chamber and received hyperbaric oxygen therapy.Meanwhile,rats in the NBP treatment group were subjected to oral NBP 6 mg/100 g twice a day additionally.The expressions ofNogo,MAG and NgR1 were investigated in rat brain tissues by immunohistochemistry and double immunofluorescence staining 1 day,3 days,1 week and 4 weeks after CO exposure.Results With the prolongation of CO poisoning,the levels ofNogo,MAG and NgR1 in brain tissues of the CO poisoning group were gradually increased,and their expressions could still be detected at 4 weeks after CO poisoning.NBP treatment group had significantly reduced Nogo and NgR1 protein levels,and statistical differences were noted as compared with those in the CO poisoning group at each time point (P＜0.05).The level of MAG in NBP treatment group was slightly lower than that in CO poisoning group without statistical difference (P＞ 0.05).Conclusions The levels ofNogo,MAG and NGR1 proteins may be associated with brain injury and demyelination induced by CO poisoning.NBP can downregulate the levels of Nogo and NgR1 proteins (but not MAG),and may play a neuro-protective role in brain damage after acute CO poisoning.