ObjectiveTo study the influence of mannitol used in eraly stage of intracranial hematoma.Methods178 cases diagnosed intracranial hematoma were divided into two groups according to the treatment.After admission,all patients were detected by CT.On the basis of the routine treatment,the treatment group(88 cases) were given mannitol within 6h after bleeding,while the control group were given nothing.To observe the change in hematoma size,GCS score and the quality of life 30d after treatment.ResultsThe experiment group's average bleeding loss was(27.6±5.7)ml,while the control group's average bleeding loss was(23.1 ±4.8)ml,the proportion of patient of treatment groups whose hematoma increased was significantly greater than the control group(P ＜0.05).At the aspect of GCS score,the experiment group was (5.0 ± 1.5 ),while the control group was ( 9.5 ± 1.5 ),the average score of treatment group was significantly lower than the control group(P ＜ 0.05).30d after treatment,14 cases of experiment group dead,the mortality rate was 15.91％,while the control group's motality rate was 7.78％.The mortality rate of treatment group was significantly higher than the control group(P ＜ 0.05).ConclusionMannitol used in early stage of intracranial hematoma promotes the growth of intracranial hematoma and increases the mortality.The patients with intracranial hematoma should avoid the use of manntol in early stage.

Medical disputes caused by suspected AIDS infection via blood transfusion are characterized by high sensitivity, involvement of many persons, great difficulty in carrying out investigation and obtaining evidence, and demand for a large compensation. The key to handling this kind of medical dispute lies in clarifying whether there is a causal relationship between the blood transfusion and the AIDS infection, whether there have been illegal activities in the process of blood collection and transfusion, and whether there is a causal relationship between such activities and the AIDS infection. In addition, the partys right of privacy should be protected. Measures of prevention include: handling without gloves activities of illegal blood supply and collection and the arrangement for other people selling their blood; strictly assessing and consolidating the blood centers; blood centers and hospitals jointly preventing the spread of AIDS via blood transfusion; taking proper care of the raw data of blood supply and collection; and speeding up the establishment of an insurance system for blood transfusion and the implementation of the States plans for AIDS prevention and treatment.

Objective To discuss the surgery for the patients with bruise of bilateral frontal lobes complicated with central encephalocele.Methods 48 patients diagnosed as bruise of bilateral frontal lobes complicated with central encephalocele were analyzed retrospectively.According to the results of CT and clinical symptoms,timing of surgery was selected.All patients were given unilateral decompressive craniectomy or bilateral decompressive craniectomy.Results All patients were followed up for 1 year.42 cases survived,while 6 cases died.All cases were estimated with GCS:18 cases ( 37.5％ ) were cured excellently,16 cases ( 33.3％ ) were mild morbidity,5 cases ( 10.4％ ) were severe morbidity,3 cases ( 6.3％ ) were in persistent vegetative state and 6 cases ( 12.5％ ) were dead.Conclusion The progression of patients with bruise of bilateral frontal lobes comphcated with central encephalocele were rapid.Diagnosis and treatment at the early stage could improve patients' prognosis.

Objective To investigate the clinical features and surgical management of giant coronary artery aneurysm due to mucocutaneous lymph node syndrome(Kawasaki disease).Methods From May 2006 to Oct.2007,5 patients with giant coronary artery aneurysm were undergone surgical correction.The aneurysm mainly appeared in the left bole of coronary artery and the right coronary artery.The ST segment of electrocardiogram changed in 5 cases,cardiac ejection fraction reduced observably in 4 cases,and 1 case suffered from cardiac dysfunction.Coronary angiography showed that the right coronary artery was entirely occluded and ventricular wall motion was depressed in one case.During operation,4 cases were undergone thrombus clearing,endoarterectomy and replasty of coronary artery(with additional procedure of stent placement in one case),one case was undergone coronary artery bypass grafting(CABG) with the aneurysm sequestration.Results The surgical results were satisfactory.No operative death occurred,and all the patients recovered uneventfully and were free of symptoms.In 4 cases,the ST segment of electrocardiogram showed that the blood supply of ischemic myocardium was improved,and the cardiac ejection fraction increased obviously.With 2 to 18 months following-up,all patients were free of symptoms with no death or coronary artery aneurysm recurrence.Conclusions For stage 3 Kawasaki disease complicated with giant coronary artery aneurysm,surgical procedure is necessary.The cardiac function can be improved greatly after comprehensive treatment of thrombus clearing,endoarterectomy,replasty of coronary artery and CABG.

Objective To discuss the risk factors of progressive hemorrhagic injury(PHI)in patients with craniocerebral injury.Methods Clinical data of 149 patients with closed craniocerebral injury were retrospectively analyzed,and the patients were divided into PHI group (42 cases)and non -PHI group (107 cases)according to PHI appeared or not.The patients were immediately given CT scan after admitted,the first CT review was given in the non -PHI group within routine 4 -8h after first CT scan,and due to deterioration of clinical symptoms,the PHI group was given CT review in advance.The intracranial hematoma volume changes between first CT and first CT review in the two groups were observed,then clinical symptoms,signs,biochemical indicators and CT performance in the two groups were compared,and analyzed risk factors of PHI.Results The intracranial hematoma volume showed in CT scan,first CT review and increment volume of the PHI group were significantly higher than the non -PHI group [(14.59 ±4.60)mL vs.(7.28 ±2.94)mL,(25.92 ±8.84)mL vs.(8.35 ±3.41)mL,(10.20 ±3.45)mL vs. (2.10 ±0.65)mL],the differences were significant (t =6.796,11.894,9.367,all P <0.05).Logistic regression analysis showed that pupil dilation,consciousness disturbance,intracranial hematoma volume >10mL were major risk factors of PHI (P <0.05).Conclusion In closed craniocerebral injury,we should pay more attention on PHI if patients with age >50 years old,mydriasis,conscious disturbance,intracranial hematoma volume >10mL in first CT scan.

Objective To measure the placing position error of different body position by analog positioning machine in patients with different body mass index (BMI) during radiotherapy for rectal cancer, then calculate the clinical target volume (CTV) to plan target volume (PTV) margins (Mptv). Methods Thirty-six patients with rectal cancer were selected, and the patients were divided into vacuum bag group (18 cases) and routine belly board group (18 cases) according to method of placing position. The BMI was calculated. Each patient was treated with positive and lateral position X-ray film before treatment and once a week during the radiotherapy. The data were contrasted with digitally rendered radiographs (DRR) of three-dimensional conformal radiotherapy plan system, then the placing position error on X, Y and Z axis was calculated, and the Mptv on X, Y and Z axis of patients with different BMI was calculated. Results The placing position error on X, Y and Z axis gradually increased with the increase of BMI in vacuum bag group and routine belly board group, and there were statistical differences (P<0.01 or <0.05). The Mptv on X, Y and Z axis in patients with normal BMI were 4.60, 5.51 and 5.29 mm respectively. The Mptv on X, Y and Z axis in patients with overweight were 5.48, 6.81 and 6.16 mm respectively. The Mptv on X, Y and Z axis in patients with obesity were 8.92, 8.59 and 7.02 mm respectively. Conclusions The rectal cancer patients with overweight and obesity have more placing position error. The influence of BMI should be considered when the patient's Mptv is determined.

Objective To summarize the clinical experience in Da Vinci surgical system-assisted hepatopancreatobiliary surgery.Methods From January to December in 2009,94 patients with hepatopancreatobiliary diseases were treated at General Hospital of Second Artillery of PLA.The surgical procedure and postoperative recovery of patients were analysed.Results A total of 90 patients had successfully undergone robotic surgery,and 4 patients were converted to open surgery with the conversion rate of 4%(4/94).Sixteen patients received surgeries for hepatic diseases,and 1 patient with a giant hemangioma in the right posterior hepatic lobe was converted to open surgery,because a very close relationship between the hemangioma and inferior vena cava was observed;27 patients received surgeries for hilar diseases;19 patients underwent surgeries for pancreatic diseases,and 3 patients were converted to open surgery,including 2 with poor exposure of the giant pancreatic head carcinoma and 1 with tumors in the distal common bile duct:32 patients received other surgeries,including 6 with choledochojejunostomy and 11 with laparoscopic common bile duct exploration.Conclusions Almost all kinds of operations for hepatopanereatobiliary diseases could be performed by Da Vinci surgical system.Da Vinci surgical system expands the indications for laparoscopic surgery.

Objective To investigate clinical manifestations and clinical diagnosis and treatment and pathological and immunohistochemical features in gastrointestinal stromal tumors. Methods The clinical data of fifty-two cases with gastrointestinal stromal tumors were collected, whose clinical diagnosis and treat-ment and pathological features were retrospectively analyzed from January 1995 to December 2007. Results All patients received operation therapy, only forty-five cases with complete surgical resection. The immu-nohistochemical staining showed that the cases with CD117 positive accounted for 100% (52/52) and CD34 positive accounted for 88.5% (46/52). Conclusions Surgery was necessary for all patients, especially complete surgical resection. Gastrointestinal stromal tumors were poor in preoperative diagnosis, which diag-nosis was based on the immunohistochemical staining of the tumor tissue. CD117 and CD34 tumor markers may help to diagnose gastrointestinal stromal tumors.

OBJECTIVETo study the injection of NKG5SV gene to inhibit growth and metastasis of hepatocellular carcinoma (HCC).

METHODSNKG5SV gene was inserted into retroviral vector pLXSN by normal methods. LacZ gene was used as control. LCI-D20 tumor together with saline, pLXSN-LacZ DNA or pLXSN-NKG5SV was subcutaneously inoculated to the nude mice. Tumor formation rate and tumor size were noted 35 days after inoculation. LCI-D20 tumor was inoculated subcutaneously. Saline, pLXSN-LacZ DNA or pLXSN-NKG5SV was intratumorally injected respectively 10 days after inoculation. Tumor growth was observed 35 days after inoculation. Liver cancer was resected 22 days after intrahepatic inoculation. Saline, pLXSN-LacZ DNA or pLXSN-NKG5SV was respectively injected at incisal margin or intraspleen. Mice were killed 35 days after inoculation to observe tumor recurrence at incisal margin, intrahepatic metastasis and extrahepatic metastasis.

RESULTSTumor formation rate and tumor diameter(cm) were 1.76 +/- 0.11, 1.51 +/- 0.34, 0.33 +/- 0.04 in the control group, LacZ group, NKG5SV group respectively when tumor and different cDNA were inoculated together. Tumor diameter(cm) and weight(g) were 0.87 +/- 0.08, 0.83 +/- 0.05, 0.26 +/- 0.04; 0.43 +/- 0.06, 0.38 +/- 0.04, 0.08 +/- 0.06 in the control group, LacZ group, NKG5SV group respectively when different cDNA were injected into the LCI-D20 tumor. Sites with extrahepatic metastasis nidi, incisal margin recurrence tumor size(cm), intrahepatic metastasis nidi, metastasis involved hepatic lobes in the control group, LacZ group, NKG5SV group were 4.25 +/- 1.48, 4.25 +/- 1.04, 0.63 +/- 0.51; 1.51 +/- 0.27, 1.35 +/- 0.17, 0.81 +/- 0.17; 2.50 +/- 1.41, 2.38 +/- 1.06, 1.25 +/- 0.71; 2.13 +/- 0.99, 2.00 +/- 0.75, 1.38 +/- 0.74 respectively when NK cells were injected at incise margin. They were 4.38 +/- 1.85, 4.25 +/- 1.48, 1.00 +/- 0.75; 1.13 +/- 0.23, 0.97 +/- 0.29, 0.76 +/- 0.16; 2.50 +/- 1.41, 2.05 +/- 1.12, 0; 2.13 +/- 0.83, 1.75 +/- 0.88, 0 respectively when NK cell were injected intrasplenicly.

CONCLUSIONSNKG5SV gene can inhibit HCC growth and postoperative metastasis and recurrence.

Animals ; Antigens, Differentiation, T-Lymphocyte ; Cell Division ; drug effects ; Genetic Therapy ; methods ; Genetic Vectors ; administration & dosage ; genetics ; Humans ; Injections ; Liver Neoplasms, Experimental ; genetics ; pathology ; therapy ; Male ; Mice ; Mice, Nude ; Neoplasm Metastasis ; prevention & control ; Receptors, Immunologic ; genetics ; physiology ; Tumor Cells, Cultured ; Xenograft Model Antitumor Assays

The most two advanced development in cancer immunotherapy: (1) Infusion with in vitro activated or gene-modified T cells; (2) Activation of suppressive immune cells by antibodies to exert cytotoxicity. The first one about gene-modified T cells is mainly referred to chimeric antigen receptor-T cells (CAR-T) that have shown the significant efficacy in some haematological malignancies. The latter one about immune checkpoint blockades takes effects on tumors with burden of gene mutations. For cancer patients, however, tumor microenvironment is suppressed highly more than the systemic immune. Normalizing or enhancing the local microenvironment by systemic activation of immune response may cause the overreaction in other normal tissues, even severe damage, for example interstitial lung diseases, acute myocarditis, and severe liver failure. This review summarizes the characterization and classification of tumor immune microenvironment, development of cancer treatment and immunotherapy, and elucidates the importance of targeting tumor immune microenvironment. The key strategy is pointed out to efficiently and precision target tumor immune microenvironment by using self-secreting antibody CAR-T cells (baize T cells), quickly enhancing the immune function in tumor microenvironment, which may eventually cure cancer.