Objective To observe the contrast sevoflurane anesthesia and propofol intravenous anesthesia in children hernia surgery anesthesia on blood flow dynamics in children to assess the quality of anesthesia, anesthesia program aims for the future choose to provide important reference for basis . Methods The surgical treatment of pediatric hernia patients from January 2012 to June 2016 was prospectively selected as the study group, and the rats were divided into two groups by random drawing method. Results There were other children point and T1 relatively SBP, DBP were significantly lower (P<0.05), the observation group were significantly lower than the control group (P<0.05), the control group of children with T2, T3 compared with T1 point HR significantly increased (P<0.05). Conclusion Pediatric hernia surgery using laryngeal mask sevoflurane anesthesia exact effect, maintaining hemodynamic stability, safety, and can be widely used in clinical.

Objective To evaluate the effects of reminfentanil combined with propofl on patients received video assisted thoracoscopic surgery. Methods 40 ASA Ⅰ～Ⅱ patients underwent video assisted thoracoscopic surgery were randomly divided into two groups. BP、HR before anesthesia induction(T0) ,tracheal induction(T1) ,tracheal induction instantly (T2), after five minutes of tracheal induction(T3) were observed; The time of breathing recovery withdrawl,and open eye,extubation and instantly of extubation,VAS;to record in the operation and adverse effect of postoperative nausea were analyzed. Results During tracheal induction, hemodynamic and respiratory variables of groupR less then group F(P ＜ 0. 05), after operation group R time of breathing recovery withdrawl, and open eye, extubation is short of group F(P ＜ 0. 05). Two groups was not appear to know in operation, postoperative nausea is not satistically significant. Conclusion General anesthesia by reminfentanil combined with Propofol on video assisted thoracscopic surgery was safe and feasible.

Objective:To assess whether Veronicastrum axillare (V. axillare) can ameliorate ethanol-induced gastric mucosal lesions in rats, reduce the production of pro-inflammatory cytokines, suppress apoptosis and improve local microcirculation disturbances.
Methods:Totally 48 male Sprague-Dawley rats were randomly divided into six groups, eight rats in each group. Rats in the normal group and the model group were administered with 0.9%normal saline respectively. Rats in the positive group and ranitidine group were administered with 0.18% ranitidine suspension by intragastric administration respectively. Those in the high dose V. axillare group, the medium dose V. axillare group and the low dose V. axillare group were administrated with V. axillare at the daily dose of 2.8 g/kg, 1.4 g/kg and 0.7 g/kg by intragastric administration. Gastric mucosal lesions were produced by intragastric administration of absolute ethanol. Water extract of V. axillare was successively injected for 14 d and last day was injected 1 h before ethanol administration. Gastric mucosal ulcer index and ulcer inhibitory rate were counted by improved Guth methods. The tissue sections were made for pathological histology analysis. Also, we measured the concentrations of tumor necrosis factor-α (TNF-α) and endothelin-1 (ET-1) in gastric mucosal, as an index of the pro-inflammatory cytokines, apoptosis and local microcirculation. Besides, the mRNA contents of TNF-αand ET-1 were measured to verify effects on gene expression by real-time fluorescent quantitative PCR.
Results: Water extract of V. axillare significantly ameliorated the gastric mucosal lesions induced by ethanol administration (P<0.01). Pro-inflammatory cytokines, TNF-αand ET-1 were increased after ethanol administration and significantly reduced by water extract of V. axillare. The expressions of TNF-αand ET-1 mRNA were also be inhibited by water extract of V. axillare.
Conclusion: Current evidences show water extract of V. axillare is effective for defending against ethanol-induced gastric mucosal lesions, significantly inhibiting the production of pro-inflammatory cytokines and the expressions of TNF-αand ET-1 mRNA, which may be useful for inhibiting apoptosis and improving local microcirculation.

Objective To investigate the efficiency and safety of endoscopic large balloon dilation following small sphincterotomy (ESBD) for treatment of common bile duct (CBD) stones, and to prospectively compare it with traditional sphincterotomy (ES). Methods Patients with single or multiple calculi in extra-hepatic bile ducts and with the diameter of CBD larger than 13 mm, were randomized into 2 groups to receive maximal sphincterotomy (ES group), or partial sphincterotomy plus sphincteroplasty with 15mm-balloon (ESBD group), respectively, followed by conventional stones removal and/or lithotripsy. The success rate of stone clearance, operation time and related complications were observed. Results A total of 86 patients were enrolled in 2 endoscopy centers, with 2 excluded because of papillary pre-cut in 1 and non-compliance with the protocol in the other, and were randomly divided into groups ES and ESBD, with 42 patients in each. The clinical characteristics, including average diameter of CBD, size and quantity of calculi, and incidences of peri-ampullary diverticulum, of patients in both groups were all similar. Stones clearance with single session in 2 groups were 88% and 93%, respectively (P =0. 531 ). The operation time were (25.76 ± 12. 74) min and (26. 38 ± 12. 86) min ( P = 0. 825 ). The rate of mechanical lithotripsy was 36% and 25%, respectively (P=0. 363). Complications occurred in 5 cases in ES group (3 mild, 2 medium), and 2 mild complications occurred in ESBD group (no statistical difference). No death happened in any group.Conclusion ESBD is an effective method for clearance of extra-hepatic bile duct stones with the similar safety, compared with traditional sphincterotomy. It could be an optimal alternative for those with large stones or difficult sphincterotomy.

Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65, average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231 patients (44.3%).The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%(34/521),in death group,the grade of ISS on average 43.6.13 cases died of hem-orrhagic shock,and 7 died of severe craniocerebral injury,4 died of cardiac injuries,3 died of ARDS due to flail chest and Severe pul-monary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3% (60/487),most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be ex-plored;use of damage control surgery (DCS)and do not importune to decide to surgery on the basis of organ damage grading in e-mergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to thelethal triadprecursor,and terminate the operation quickly when it happens.

Objective To summarize the pathogenesis,diagnosis and treatment of aplasia cutis congenita (ACC) in China.Methods We reviewed and summarized all published ACC cases in China in the past four decades from China National Knowledge Internet(CNKI),Wan-Fang Medical Database and VIP database.Results Totally,258 cases were included,consisting of 144 males,95 females and 19 of unknown gender.Fifteen cases reported family history,16 had maternal morbidity during pregnancy,17 exposed to maternal medication or toxic material.Skin lesions of ACC occurred on the scalp (39 cases,15.1％),trunk (8 cases,3.1％) or limbs (107 cases,41.5％) and sometimes were manifested as multiples skin defects (104 cases,40.3％).Eighty-nine cases (38.4％) were presented with isolated skin defect,and 169 (61.6％) were complicated by other abnormalities or congenital defects.Totally,235(91.1％) cases were treated conservatively,15 cases with dural defect,skull defect or defect area ＞ 10％ underwent dermatoplasty,and the other eight cases refused any treatment.Among the 248 cases being followed up,233 (93.95％) healed after treatment for one week to four months,three had scar contracture,four developed joint contracture,and eight (3.2％) died of hemorrhage or infection.Conclusions ACC is a congenital skin defect which might involve skin,bone and multiple parts of the body,often complicated with other abnormalities.Superficial and small skin defect maybe managed conservatively,while for patients with bone exposure or defect,large area skin defect,surgical management is recommended.Appropriate management can ensure good outcomes in most cases.

Objective To explore the clinical efficacy of 3D printing technique in assisting sacroiliac screwing in combination with front ring nail-rod system for treatment of unstable pelvic fractures.Methods From July 2015 to June 2017,3D printing technique was used to assist the sacroiliac screwing in combination with front ring nail-rod system for 16 patients with unstable pelvic fracture at Orthopaedic Center,The Fourth People's Hospital of Zigong.They were 9 males and 7 females,aged from 19 to 60 years (average,39.8 years).By the Tile classification,5 cases were type B1,6 type B2,3 type B3 and 2 type C.Their operation duration,bleeding,fluoroscopy frequency,incision length,postoperative fracture reduction,success rate of sacroiliac screwing,accuracy of sacroiliac screwing,perioperative complications,weight-bearing exercise time,fracture healing time and the Majeed scores at the last follow-up were documented.Results All the 3D models and navigation templates were successfully designed and printed.Surgery succeeded in all the patients.Follow-ups ranged from 6 to 18 months,averaging 13.3 months.The bleeding ranged from 100 to 250 mL,averaging 162.4 mL;the operation duration ranged from 60 to 120 min,averaging 73.2 min;the intra-operative fluoroscopy frequency ranged from 13 to 31 times,averaging 17.4 times;the incision length ranged from 16 to 32 cm,averaging 21.1 cm.All the incisions healed by the first intention and all the fractures obtained osseous union after 90 to 120 d (average,102.3 d).No significant complications like neurovascular injury or pulmonary embolism happened.The weight-bearing exercise time ranged from 25 to 40 d,averaging 31.5 d.According to the Matta imaging scores,the reduction was rated as excellent in 12 cases and good in 4.Altogether 28 screws were inserted with a success rate of 100％.Compared with the preoperative simulated screwing,the actual screwing angle deviated postoperatively by 0.12° ± 0.32°,the X axis by 0.36 ± 1.24 mm,the Y axis by 0.36 ± 1.24 mm and the Z axis by 0.22 ± 1.26 mm,showing no statistically significant difference between the actual 3D deviations and the test value of 0 (P ＞ 0.05).Conclusion In the treatment of unstable pelvic fractures,3D printing technique can be used in preoperative preparation of the connecting rod in the front ring nail-rod system to assist the sacroiliac screwing,significantly shortening the operation duration,reducing bleeding,ensuring safe and accurate screwing,and facilitating functional recovery.

Objective To investigate the effect and its mechanism of D-pinitol on advanced glycation end products(AGEs)-induced proliferation and migration in mouse aortic vascular smooth muscle cells (VSMC).Methods VSMCs were isolated from mouse aorta and cultured in vitro.Effects of different concentrations of D-pinitol on proliferation and migration of VSMCs were observed by using the AGEs-induced glycosylation injury model of VSMCs.Cell proliferation and migration were detected by CCK-8 assay and cell scratch,respectively.The protein expression levels of transforming growth factor-β1(TGF-β1),p-smad2,p-smad3 and asporin were determined by Western blot.Results Compared with control group,AGEs group showed the increased protein expression levels of asporin,TGF-β1,p-smad2 and p-smad3 (40.06 ± 4.50 vs.17.47 ± 0.57),(55.25 ± 2.07 vs.14.42± 2.07),(0.97 ± 0.02 vs.0.47 ± 0.02),(0.45±0.01 vs.0.26 ± 0.02),all P＜ 0.01.Compared to AGEs group,D-pinitol group could inhibit the cell proliferation and migration and cause dose-dependent decreases of protein expressions of TGF-β1,p-smad2,p-smad3 and asporin(P ＜ 0.05 or P＜0.01).Conclusions D-pinitol can inhibit AGEs-induced cell proliferation and migration in mouse aortic VSMCs.Asporin may participate in the VSMCs extracellular matrix remodeling via TGF-β/smad pathway.

Objectives To evaluate the 3D printed navigation template used to assist axis pedicle lag-screw placement in the treatment of atypical Hangman's fracture(AHF).Methods From May 2015 to January 2017,12 patients with AHF were treated at Department of Orthopedics,The Fourth Peopled Hospital of Zigong.In their operation,the axis pedicle lag-screw placement was assisted by a 3D printed navigation template.They were 8 men and 4 women,aged from 27 to 53 years(average,45.6 years).There were 7 cases of type Ⅰ,4 cases type Ⅱ and one case of type HA according to the Levine-Edwards classification.There were 2 cases of grade D and 12 cases of grade E according to the assessment of America Spinal Injury Association(ASIA).Their preoperative and postoperative neck pain was evaluated by visual analogue scale(VAS);their preoperative and postoperative ranges of cervical motion were recorded and compared.To evaluate the postoperative safety of screws,the insertion point,position within the pedicle,axial angle and sagittal angle of the screws and maximum fracture displacement were compared between actual operation and simulative operation.Results A total of 12 guide plates were designed and printed;a total of 24 lag-screws were placed.All patients underwent surgery uneventfully.They were followed up for 12 to 20 months,with an average of 14.7 months.Two patients with ASIA grade D recovered to ASIA grade E at the last follow-up.All patients showed a significant improvement in neck pain.Their VAS score at 5 days after surgery(5.86±2.02) was significantly lower than their preoperative score(8.29±1.88)(P<0.05) and their VAS score at the last follow-up(1.73±0.87) was also significantly lower than that at 5 days after surgery(P<0.05).Their range of cervical motion at 6 months after surgery was significantly larger than that at 3 months after surgery(P<0.05);their range of cervical motion returned to normal roughly at the last follow-up,showing no significant difference from that at 6 months(P>0.05).Their postoperative X-ray and CT images showed that the dislocation was all corrected.The last follow-up showed no obvious vertebral instability,screw breakage or loosening.Postoperative CT showed that the 24 screws had been located completely in the pedicle(grade 0),indicating that the screw placement was 100% accurate.The postoperative deviation at insertion point(0.70±0.78 mm),deviation within the pedicle(1.3±0.82 mm),axial angle(8.26°±0.88°) and sagittal angle(22.62°±0.86°) of the screws showed no significant differences from the preoperative simulative data(P>0.05).There was a significant difference in the maximum fracture displacement between the preoperative data(3.94±0.38 mm) and the postoperative data(2.21±0.39 mm)(P<0.05).Conclusion The 3D printed navigation template can be used to better assist axis pedicle lag-screw placement in the treatment of AHF,because it ensures safe screw placement,leading to good reduction and fixation and precise match with the preoperative plan.

The purpose of this study is to establish and apply a correction method for titanium alloy implant in spinal IMRT plan, a corrected CT-density table was revised from normal CT-density table to include the density of titanium alloy implant. Dose distribution after and before correction were calculated and compared to evaluate the dose deviation. Plans were also copied to a spinal cancer simulation phantom. A titanium alloy fixation system for spine was implanted in this phantom. Plans were recalculated and compared with the measurement result. The result of this study shows that the max dose of spinal cord showed significant difference after correction, and the deviation between calculation results and measurement results was reduced after correction. The method for expanding the range CT-density table, which means that the density of titanium alloy was included, can reduce the error in calculation.
Radiotherapy, Intensity-Modulated/methods* ; Titanium ; Radiotherapy Dosage ; Alloys ; Radiometry/methods* ; Radiotherapy Planning, Computer-Assisted/methods*