5). Conclusions Q-switched alexandrite laser is an effective approach to the treatment of care -au-lait spots, and its efficacy can be predicted according to different factors that concern.

AIM: To observe the efficacy and compliance of cetirizine hydrochloride and pranoprofen eye drops on children with vernal keratoconjunctivitis.
● METHODS: A total of 63 children with vernal keratoconjunctivitis, from the outpatient department in our hospital between Jan. 2014 and Dec. 2015, were randomly divided into two groups including experimental group and control group. The cases in experimental group were treated with cetirizine hydrochloride, 2 times/d, 5 drops (0. 25ml, 2. 5mg) each time (≤6 years) or 10 drops (0. 5ml, 5mg) each time (>6 years), oral or oral with beverage and food, 1g/L pranoprofen eye drops, 4 times/d, 1 drop each time. The cases in control group were only treated with cetirizine hydrochloride, 2 times /d, 5 drops (0. 25ml, 2. 5mg) each time (≤6 years) or 10 drops (0. 5ml, 5mg) each time (>6 years), oral or oral with beverage and food for 14d. All the children were detected the scores of symptom and pathology before and after treatment. Compliance and side effect of the drug were surveyed by questionnaire.
● RESULTS: The scores of symptom, pathology and overall total after treatment were significantly lower than those before treatment in each group ( texperimental, symptom =10. 41, P < 0. 05; texperimental, pathology = 10. 05, P < 0. 05;texperimental, overal =10. 75, P<0. 05;tcontrol, symptom=8. 11, P<0. 05;tcontrol, pathology=8. 89, P<0. 05; tcontrol, overal =8. 41, P<0. 05). The scores of symptom, pathology and overall total in experimental group were lower than those in control group after the treatment (tsymptom=5. 27, P<0. 05; tpathology=3. 97, P<0. 05;toveral =4. 32, P<0. 05). The effective rate of experimental group ( 85%) was significantly higher than control group (60%) (χ2 =4. 92, P<0. 05). Most of the children ( 94%) had very good compliance. None of children had side effect such as sleepiness and thirst.
● CONCLUSION: Cetirizine hydrochloride and pranoprofen eye drops in combination may offer a safety and effective treatment on children with vernal keratoconjunctivitis and have good compliance.

Objective To investigate the pathogens and resistance of stroke-associated lower respiratory tract infection in elderly patients. Methods All the clinical isolates from sputum were analyzed retrospectively. Results There were 51 (79.7%) strains of Gram-negative bacilli, 11 (17.2%) strains of Gram-positive bacteria and 2 (3.1%) strains of fungi. The most important Gram-negative pathogens were Escherichia coli, Pseudomonas aeruginosa, Alcaligenes, Klebsiella, Acinetobacter baumanii, Stenotrophomonas maltophilia. Strains of Gram-negative bacteria were susceptible to imipenem, ceftazidime and amikacin, all strains of Gram-positive pathogens were susceptible to norvancomycin. Conclusion Gram-negative bacilli are the major pathogens in stroke-associated lower respiratory tract infection in elderly patients and the dominant is conditional pathogen.

Objective To explore the feasibility of Video-Assisted Thoracic Surgery(VATS)in the treatment of mediastinal diseases. Methods 39 patients underwent VATS for mediastinal diseases from May 1994 to February 2002.There were 20 males and 19 females with a mean age of 44.9 years(range 25～75 years).13 patients with thymoma,2 patient with invasive thymoma,10 patients with neurogenic benign tumor,3 patients with esophagus cyst,3patients with bronchus cyst,2 patient with pericardial cyst,1 patient with teratoma and 5 patients with other conditions were included in the study.General anesthesia,double lumen endotracheal tube placement and single lung ventilation were used.The patients were placed in the lateral decubitus position with 15? slope forward for posterior mediastinal mass or with 15?～30? slope backward for anterior mediastinal mass.The camera port was placed in the sixth or the seventh intercostal space between the anterior anxillary line and posterior anxillary line.Two or three ports placed according to the site of the tumor permitted an adequate working distance that maximized the range of dissection within the chest.Mini-invasive thoracotomy combined with VATS were performed for some patients when the solid tumor was more then 5 cm in diameter or when it was closely adhesire to surrounding organs Results All patients recovered uneventfully.36 patients underwent tumor removal by VATS alone and 3 patients received mini-invasive thoracotomy combined with VATS performance.The overall incidence of postoperative complication and mortality rate were 0. Conclusions VATS is a safe and effictive technique in the selective patients with mediastinal masses.

Cerebral Cortex ; physiology ; Humans ; Neural Pathways ; physiology ; Taste

Objective To evaluate the safety and efficacy of pancreatic duct precutting by arciform knife combined with needle knife in difficult cannulation of ERCP.Methods The clinical data of 38 patients who were treated with pancreatic duct precutting by arciform knife combined with needle knife in our hospital from June 2005 to May 2012 were retrospectively reviewed.Results The success rate of ERCP was 86.8％ (33/38) without any complications of bleeding or perforation,while 4 cases were presented with hyperamylasemia after ERCP,4 with pancreatitis and 1 with cholangitis who all got recovered after 5 days with conservative treatment.Conclusion The application of pancreatic duct precutting by arciform knife combined with needle knife can improve the success rate of ERCP and is a kind of effective operation technique.

Objective To evaluate the safety and efficacy of endoscopic intraductal radiofrequency ablation combined with biliary metal stent and biliary metal stent only for the treatment of biliary malignant tumor.Methods Data of 48 patients with biliary malignant tumor were reviewed.All patients were examined by ERCP for the range of obstruction.Twenty-four patients received combined therapy (combination group),while 24 others received stent placement only (control group).In the combination group,stenotic segments were treated with intraductal radiofrequency ablation,then metal stents were placed into the biliary duct.In the control group,only metal stents were placed.Changes of serum total bilirubin (TB),surgical complications,days of stent patency and median survival time were studied.Results In the combination group,TB level [median (min-max)] was 238.15 μmol/L (22.10-410.70 μmol/L) before treatment and it decreased to 113.40 μmol/L (9.80-243.70 μmol/L) after,while in the control group it was 239.70 μmol/L(112.30-558.50 μmol/L) before and 121.10 μmol/L (52.10-329.30 μmol/L) after respectively,significantly different in both groups (P＜0.05).The time of stent patency was 156 days (44-530 days) in the combination group and 110 days (14-462 days) in the control group (P＜0.05).The median survival time was 173 days (44-550 days) and 133 days (14-490 days) respectively(P＜0.05).Conclusion The combination therapy of endoscopic intraductal radiofrequency ablation with biliary stent is safe and feasible for biliary malignant tumor.It can prolong the duration of stent patency and median survival time as well as improve postoperative survival quality.

Objective Currently, the effect of hydrogen peroxide solution( H2 O2 ) flush on the recovery of peripheral nerve injury are still undetermined. This study aims to explore the effects of different H2 O2 flushing time course on recovery of peripheral nerve injury during surgical debridement. Methods 18 New Zealand male white rabbits were randomly divided into isotonic saline group( isotonic saline flush) , H2 O21 min group ( hydrogen peroxide solution flush 1 min + isotonic saline flush) , H2 O23 min group ( H2 O2 flush 3 min + isotonic saline flush. Each group has 6 rabbits. We established rabbit sciatic nerve injury model. After 12 weeks, we executed the animals, drew materials at the suture nerve, detected motor nerve conduction velocity and observed pathological HE staining, as well as measuring the sciatic nerve function indexes( SFI) of rabbits at the 8th and 12th week, respectively. Results Nerve conduction velocity in H2O21min group and isotonic saline group[(25.89±1.42), (26.46±1.67) m/s] were higher than that in the H2O23min group[(23.80±2.91)m/s](P<0.05). Pathological section shows that the isotonic saline group has a better sheathstructure, nerve fibers structure damage is not obvious and myelin degeneration degree is mild in H2 O21 min group. blurred sheath structure and myelin axons obvious deformation in H2 O23 min group. 8 weeks and 12 weeks after operation, SFI in isotonic saline group [(-43.00±0.82), (-39.17±0.91) m/s] was significant higher than H2O21 min group [ (-49.79±1.47), (-46.60±0.79) m/s] and H2O23min group [(-51.66±1.27), (-46.39±0.94) m/s], thedifference was statistically significant (P<0.05). SFI in group of H2O21min [(-49.79±1.47)m/s] was higher than group og H2O23 min [(-51.66±1.27) m/s][P<0.05]. Conclusion H2O2 solution has side effect on the recovery of damaged peripheral nerve inju-ry and with prolonging the H2 O2 flushing time, the damage of peripheral nerve can be aggravated. So in the process of clinical surgical debridement, under the premise of guaranteed sterilization the time of H2 O2 flush should be shortened as far as possible.

Objective To analyze the relative factors of functional recovery after upper limbs replantation. Methods From September, 2009 to March, 2014, 24 consecutive patients after upper limb replantation for amputation were retrospectively analyzed. The Disability of Arm Shoulder and Hand (DASH) was used to assess the functional recovery of the upper limbs at the last follow-up. The non-conditional Logistic regression was used to analyze the correlation of gender, age, time from injury to surgery, amputated level, amputated method, isch-emia hours, dominant hand or not, rehabilitation treatment, rehabilitation duration, and the DASH scores. Results The DASH score was>28.50 in 15 patients, while ≤28.50 in 9 patients. The Logistic regression analysis demonstrated that amputated method and rehabilitation treatment correlated with the functional recovery of upper limbs (χ2>7.360, P<0.05), and no correlation was found in the other factors (χ2<3.789, t=1.515, P>0.05). Conclusion The amputated method and rehabilitation treatment after operation are the factors related to the func-tional recovery after upper limb replantation.

Objective To analyze the levels of Th17,CD4+ CDhigh25and the related cytokines (IL-17,IL-21,TGF-β,IL-10)in the plasma of patients with SLE.Methods The percentage of Th17 and CD4+ CDhigh25 Treg cells in peripheral blood were examined by flow cytometry.QRTPCR was used to detect the mRNA expression level of RORγt and Foxp3 of 56 SLE patients (26 patients are inactive and 30 patients are active) and 28 healthy controls.Plasma cytokines levels were measured by ELISA.Results The percentage of Th17 cells in patients with SLE was higher than that of healthy controls [ (3.44 ± 0.96) ％ vs (2.42 ± 0.52) ％,t =5.38,P =0.000 ].The percentage of CD4+ CDhigh25 Treg cells in patients with SLE was lower than that of healthy controls [ ( 1.32 ± 0.57 ) ％ vs ( 2.07 ± 0.67 ) ％,t =3.28,P =0.034].The expressions of RORγt mRNA was increased compared with healthy controls[ (0.219 ±0.063) vs (0.087 ± 0.045 ),t =6.41,P =0.000 ],but the expressions of Foxp3 mRNA was decreased compared with healthy controls [ (0.063 ±0.045) vs (0.128 ±0.056),t =5.28,P =0.000].Plasma levelsof IL-17,IL-21 and IL-10 in SLE patients were 122.4 ( 60.5 - 188.3 ),167.2 ( 128.7 - 871.4 ),51.3(20.9 - 123.7 ) ng/L,respectively,and in the control group were 27.1 ( 18.1 - 86.2 ),31.0 ( 31.0 -424.5),33.5( 16.4 - 54.1 ) ng/L,respectively,they were significantly different between the two groups (Z =3.83,4.54,1.87,all P ＜ 0.05 ).However,TGF-β levels were markedly decreased in SLE patients compared with controls [ 31.0 ( 31.0 - 168.6 ) ng/L vs 159.8 ( 63.4 - 389.7 ) ng/L,Z =4.87,P ＜0.05.IL-17 was positive correlation with Th17 cells,SLEDAI score,dsDNA antibody titers ( r =0.621,0.581,0.512,respectively,all P ＜ 0.05 ),but was negative correlation with C3 ( r =- 0.543,P ＜ 0.05 ) in SLE patients.Although the percentage of CD4 + CDhigh25 Treg cells were negatively correlated with SLEDAI score ( r =- 0.423,P ＜ 0.05 ),it was positively correlated with C3 ( r =0.511,P ＜ 0.05 ).Conclusion This study suggests that the imbalance of Th17 cells and CD4+ CDhigh25 Treg cells and the disorder of related cytokines are important in the pathogenesis of SLE patients.