Objective To explore a safe,high efficiency and rapid approach for the repair of huge sacral pressure sores. Methods From 1993 to 2001,17 cases of huge sacral pressure sore were repaired using the pedicled upper part gluteus maximum myocutaneous flap .Results The outcome of repair in stage Ⅰ was satisfactory in all the cases during the followed-up period for 1～9 years,the size of the flap ranged from 16cm?10cm to 10cm?8cm,No recurrence was occurred,The function of gluteus in donor areas was keeped maximally. Conclusions The method is a good treatment for huge sacral pressure sores. It possesses the advantages of easiness to perform,rich blood supply,no necessity of free skin graft in the donor areas,less complications,high success rate. The treatment can be completed in one stage.It is worthy of popularization.

Objective To study the causes of misdiagnosis for differentiated thyroid carcinoma in teenager, the re-operative indication and style as well as the prevention of complication. Methods The clinical data of 36 cases of re-operative treatment for differentiated thyroid carcinoma in teenager from 1991 to 2002 were analyzed retrospectively.Results The incidence of residual cancer and cervical lymphnode metastasis in the patients was 38.9% and 30.5% respectively. The re-operative complications included 2 cases of hoarseness, and 3 cases of hand and foot spasm. Five-year and ten-year survival rates after reoperation were 90.4% and 88.9%, respectively. Conclusion Thyroid nodules in teenager should be guarded against malignancy. FNAB(Fine-Needle Aspiration Biopsy) is helpful for diagnosis before the operation, and pathological observation of frozen section during operation must be performed as routine examination. Choosing suitabel operative style could raise the operative excision rate and quality of life. The improved operation skill could reduce the operative complications.

Objective To systematically review the short-term and long-term efficacy of eversion carotid endarterectomy (eCEA) and patch carotid endarterectomy (pCEA) for the treatment of carotid artery stenosis.Methods The published literature on eCEA and pCEA control studies in medline,PubMed,Ovid,CNKI and CBM (1970.5-2016.10) databases were retrieved by computers.Two reviewers selected literature and extracted data independently according to the inclusion and exclusion criteria.Cochrane Collaboration Network Special Software Rev Man 5.2 was used to analyze the meta-analysis of short-term and long-term outcome measures.Results A total of 1 137 articles were retrieved.Ten studies were included and analyzed (3 of them were randomized controlled trial).A total of 3 213 patients were enrolled,including surgical intervention 3 299 case/time (1 512 in the eCEA group and 1 787 in the pCEA group).The results of meta-analysis showed that:(1) the mean operative time in the pCEA group was shorter 22±8 min than that in the pCEA group.The intraoperative utilization ratio of shunt tube,eCEA was significantly lower than pCEA,they were 12.6 %(53/421) and 50.2% (357/711) respectively (OR,0.11,95%CI 0.08-0.15,P<0.01).The postoperative incidence of stroke within 30 d (OR,0.42,95%CI 0.23-0.76,P=0.004) and the incidence of stroke after 30 d in eCEA were lower than those in pCEA (OR,0.26,95%CI 0.09-0.78,P=0.02).There was significant difference.(2) eCEA reduced the incidence of restenosis at day 30 after procedure (OR,0.57,95%CI 0.38-0.86,P=0.008).Conclusion Compared with pCEA,eCEA has the advantages of reducing the operation time and lowering the utilization rate of shunt tube.At the same time,eCEA can reduce the occurrence of stroke within 30 d and 30 d after procedure,and significantly reduce the incidence of restenosis.

Objective To evaluate the monitoring value of serum albumin and plasma von willebrand factor in patients with stroke.Methods Serum albumin and plasma von willebrand factor were measured from 145 patients with stroke(95 patients with nonpoor outcome and 50 patients with poor outcome) in two weeks and after six months from stroke onset to study the relationships with prognosis.Results Serum albumin level was significantly higher in patients with nonpoor outcome(mRS≤2) after six months stroke onset than those with poor outcome(mRS≥3) and was lower after six months stroke onset than in two weeks from stroke onset.On the other hand,plasma vWF level in patients with stroke was significantly higher than that in healthy controls and was higher in two weeks than after six months from stroke onset.Patients with poor outcome had higher plasma vWF level than patients with nonpoor outcome in two weeks and after six months from stroke onset,but had no significant difference.Conclusion The level of serum albumin and plasma von willebrand factor is related with nutritional status,active extent and prognosis in patients with stroke.

Objective To study the technique and clinical effect of endoscopic surgery using high frequency electrotome with suction device for nasopharyngeal angiofibroma. Methods In this study, we retrospective analyzed the clinical data of 10 patients treated between January 2009 and December 2015. All these patients were treated by endoscopic surgery using high frequency electrotome with suction device. The average blood loss during surgery, tumor residual, recurrent tumor and duration of recovery were evaluated. Results The tumor was completely removed in all 10 patients. The average blood loss was 465 ml, there was no postoperative complication, all patients had no residual tumor, and there was no recurrent tumor over a follow-up of 6~18 months. Conclusion Though it was not preoperative transcatheter arterial embolization, the endoscopic surgery using high frequency electrotome with suction device can be used to treated nasopharyngeal angiofibroma which either limited to nasopharyngeal cavities and paranasal sinus with intraoperative blood pressure control.

Non-motor symptoms are important components of the manifestations of Parkinson's disease, usually including neuropsychotic symptoms, sleep disorder, autonomic dysfunction, feels obstacle, and so on. This paper reviewed the manifestation, relevant factors,pathogenesis and treatment of non-motor symptoms of Parkinson's disease.

ObjectiveTo investigate the safety and efficacy of carbon dioxide ( CO2 ) insufflation during ERCP.MethodsBetween January and August 2011,a total of 102 consecutive patients who underwent ERCP were randomized to accept CO2 insufflation ( n =52 ) of air insufflation ( n =50 ) during the procedure.ERCP was carried out with the same instrument by an expert endoscopist who was blinded to the insufflation gas used and the procedure was controlled at 30 minutes to 1 hour.The heart rate,oxygen saturation of the patient was continuously monitored during the procedure.Before the procedure and 1 hour after the end of operation,abdominal X-ray was taken to evaluate the width of intestine,and the degree of intestinal expansion was defined as normal,mild,moderate and severe according to the width increased.A questionnaire with 100 mm visual analogue scale (VAS) was used to quantify the abdominal pain and distention experienced at 1 hour,2 hours,and 6 hours after the procedure.The patients' vital signs,bowel dilatation,the average operating time,abdominal pain score and distention score on VAS,and complications in 2 groups were analyzed.ResultsThe baseline characteristics of 2 groups were comparable.ERCP was successfully performed in all the patients and no complication was observed.In CO2 group,the average operating time,mean heart rate and oxygen saturation were (45.2 ± 10.6) min,( 102.2 ± 10.3 ) bpm and ( 99.5 ± 0.5)％,which were (48.5 ± 11.2) min,( 100.3 ± 11.4) bpm and (98.9 ±0.6)％,respectively,in air group.There were no significant differences on these items between the 2 groups ( P ＞ 0.05 ).Moderate to severe intestinal expansion 1 hour after ERCP was found in 14 patients (26.9％ ) in CO2 group and in 28 patients (56.0％ ) in air group,and the latter was significantly higher than the former (x2 =11.61,P =0.009).Both of the mean abdominal pain and abdominal distention scores at 1 hour post-ERCP in CO2 group were lower than those in air group,but without significant difference (P ＞0.05).However,the mean abdominal pain scores at 2 hours and 6 hours post-ERCP in CO2 group were significantly lower than those of patients in air group (7.4 ±2.2 vs.18.7 ±4.6 at 2 hours post-ERCP,9.6 ±3.7 vs.20.1 ±4.5 at 6 hours post-ERCP,all P ＜ 0.05 ).Similarly,the mean abdominal distention scores at 2 hours and 6 hours post-ERCP in CO2 group were significant lower than those of patients in air group (7.6 ±3.6 vs.18.3 ±4.1 at 2 hours post-ERCP,8.9 ±3.7 vs.19.4 ±4.2 at 6 hours post-ERCP,all P ＜0.05).ConclusionThe use of CO2 insufflation instead of air during ERCP appears to be safe.Insufflation of CO2 during ERCP palliates the intestinal expansion,post-ERCP abdominal pain and distention comparison to insufflation of air.However,because of the single-center clinical observation with limited number of cases,the safety and efficacy of CO2insufflation during ERCP requires to be further evaluated.

Objective:To evaluate the usefulness of fast FLAIR pulse sequence in the MRI of intraspinal canal disease.Methods:Forty-four patients with suspected intraspinal canal disease were imaged with fast FLAIR pulse sequence after routine T1 and T2 weighted imaging in a 0.5 T superconducting MR scaner.The parameters of FLAIR were TR/TI/TE=6000/1500～2000/90～120 ms.Results:There were 26 intraspinal extramedullary tumors,4 intramedullary tumors,11 myelitis,3 localized ischemic necrosis or malacia of spinal cord.The images of FLAIR pulse sequence clearly detected all lesions of the 44 cases.They were superior to routine T2 weighted images in demonstrating the extent of the lesions and their T2 signal character,expecially in inflammatory disease of spinal cord.Conclusion:FLARI is a very useful pulse sequence in the MRI of intraspinal canal disease,it may be use as an important supplement of routine T2 weighted sequence.

ObjectiveTo explore the relationship of trefoil factor family 3 (TFF3),vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF)-1α in gastric cancer SGC-7901 cells under hypoxic condition and try to investigate the mechanism of TFF3 in the genesis and development of gastric cancer. Methods The hypoxic model of gastric cancer SGC-7901 cell was induced by CoCl2 Gastric cancer cell line SGC-7901 cells were transfccted with pU6-siTFF3 plasmid which carrying RNAi targeted to human TFF3 and pU6-mock.Puromycin was selected as screening medicine.The stable and specific TFF3 inhibited gastric cancer cell line was established. Gastric cancer cell line SGC-7901 and TFF3 RNAi targeted gastric cancer cell line SGC 7901 were cultured under hypoxic condition and normoxic condition. The expression of TFF3,VEGF and HIF-1a at protein and mRNA level were detected by RT-PCR,Western blot and ELISA assay.The distribution and expression of TFF3 and HIF-1α in gastric cancer cell line SGC-7901 cells uuder normoxia and hypoxic condition were determined with immunofluorescence staining.Results The expressions of HIF-1a,TFF3 and VEGF in gastric cancer SGC-7901 cell increased under CoCl2 induced hypoxic condition (33.4 =1.8,14.8 ± 1.1 and 15.1 ± 1.2,respectively). Under hypoxie condition,the expression of VEGF and HIF-1α protein reduced in stable TFF3 RNAi SGC-7901cells.Conclusion TFF3 mediated the regulation of VEGF and HIF-1α expression under hypoxic condition.TFF3might be a potential anti-angiogenic target in gastric cancer treatment.

Objective To observe the relationship between plasma level of homocysteine(HCY) and ischemic stroke in young and middle-aged adults,explore the clinical signficance concerning the occurrence and development of ischemic stroke in young and middle-aged adults.Methods The plasma homocysteine level of 132 young and middle-aged adults patients with ischemic and 86 control peoples were measured by means of enzymatic cycling assay.Results The plasma homocysteine level in ischemic stroke was higher than that in control group( P ＜ 0.01 ).The higher the plasma homocysteine level,the larger infarcted focus in acute ischemic stroke group of young and middleaged adults.The plasma homocysteine level and the infarcted focus was positively linearly correlated.Conclusion Hyperhomocysteinemia is a risk factor of ischemic stroke among young and middle-aged adults.The higher the plasma homocysteine level,the larger infarcted focus in acute ischemic stroke group.The plasma homocysteine level can reflect the size of the infarcted focus and the degree of disease,and the plasma homocysteine level should serve as a kind of regular examination or as an index intervention can be taken,all of which are great importance to prevent ischemic stroke and reduce its morbilily.