The author selected the acupoints Fengfu (GV 16), Fengchi (GB 20), Hegu (LI 4),Jianjing (GB 21), and adopted manual techniques such as Yizhichan-Thumb waving pressing,An-pressing, Rou-stationary circular pressing, Nie-pinching, Nian-finger twisting, Na-holding,Yao-rotation and Cuo-palm twisting to warm and dredge meridians and collaterals, promote the circulation of qi and blood, and lubricate the joints, to treat 150 cases of infantile brachial plexus injury. The total effective rate was 99.3%.

Objective To observe the effects of intermittent hypoxic preconditioning on the expression of apoptosis-related EPO after 70％ hepatectomy combined with ischemia-reperfusion injury.Methods One hundred and twenty healthy SD rats of clean grade,simple random divided into 3 groups:Sham operation group of 40 rats ; Pure major hepatic resection group was 40 (Major hepatectomy,MH),namely in the hepatic portal blocking liver resection of the left and middle lobes,hepatic portal blocking 20 min ; intermittent hypoxia preconditioning group 40 (Intermittent hypoxia preconditioning,IHP group).Results MH group,S group,IHP group,EPO level in three experimental groups in postoperative residual liver tissue in rats with significant difference (P ＜ 0.05),Intermittent hypoxia preconditioning group of residual liver EPO content was significantly higher than that of simple hepatic resection group 40.Conclusion Intermittent hypoxia preconditioning can promote the expression of residual liver after hepatectomy in EPO.

Objective To observe the effects of intermittent hypoxic preconditioning on the expression of apoptosis-related Bcl-2 and Bax protein after 70％ hepatectomy combined with ischemia-reperfusion injury.Methods A total of fifty-four SD rats were randomly divided into three groups (n =18).Partial hepatectomy hroup (PH Group):Rats underwent the left and middle lobectomy of liver(70％ hepatectomy).Ischemia reperfusion group (IR group):The left and middle lobes of liver were resected during the occlusion of the hepatoduodenal ligament for 20 minutes.Residual liver underwent the process of ischemia-reperfusion.Intermittent hypoxia preconditioning group (IHP group):rats were exposed to hypoxic environment of 10％ oxygen for 1 h/d.After 7 consecutive days,the left and middle lobes of liver were resected under the portal triad clamping.At 12,24 and 48 hours after the operation,the rats were killed and detected.The serum levels of ALT and AST were determined by automatic biochemical analyzer.The expression of Bcl-2 and Bax protein in liver tissue were measured by immunohistochemistry.Results At each time point after surgery,the serum levels of ALT and AST in IR group and IHP group were higher than that of PH group,and IHP group were lower than in IR group.Compared with IR group,the expression of Bcl2 protein significantly increased and Bax protein expression significantly decreased in IHP group.All these differences were statistically significant (P ＜ 0.05).Conclusions Intermittent hypoxic preconditioning might protect residual liver against ischemia reperfusion injury,through increasing the expression of Bcl-2 protein and reducing the expression of Bcl-2 protein to decrease liver cell apoptosis.

Objective To investigate the effects of intermittent hypoxic preconditioning on residual liver regeneration after parital hepatectomy in rats.Methods Fifty-four Sprague-Dawley rats were randomly divided into 3 groups (each group contained eighteen animals):sham operation group (SO group),parital hepatectomy group (PH group)and intermittent hypoxic preconditioning group (IHP group).The rats in PH group underwent the left and middle lobectomy of liver(70％ hepatectomy).The rats in IHP group were exposed to hypoxic environment of 10％ oxygen for 1 h/d.And after a week,the rats underwent parital hepatectomy.Six rats in each group were sacrificed respectively on postoperative day 1,3 and 5 (POD 1,3 and 5).The resected liver and the regenerated liver were weighed to calculate liver regeneration degree and regeneration index.The values of alaninea minotransferase (ALT) and aspartate aminotransferase (AST) in the inferior vena venous blood were examined by automatic biochemical analyzer.The positive ratio of hepatocellular proliferating cell nuclear antigen (PCNA) in the residual liver was investigated immunohistochemically.Results The degree and index of liver regeneration in IHP group were respectively higher than those in PH group on POD 1 and 3(P ＜0.05),but there were no statistical differences between the two groups on POD 5.The levels of ALT and AST in PH and IHP group began to decline after surgery,but they remined higher than those in SO group.Moreover,the ALT and AST levels in IHP group were significantly lower than those in PH group on POD 1 (P ＜0.05).The positive ratios of hepatocellular PCNA were respectively higher than those in SO and PH group on POD 1,3 and 5 (P ＜ 0.05).Conclusions To some extent,preoperative intermittent hypoxic preconditioning could prevent hepatocellular damage after parital hepatectomy,what is more,it also could promote the remnant liver regeneration.But the mechanism still needs to be studied furter.

Objective To explore the impact and significance of hypoxia preconditioning on the expression of cytochrome C and caspase 3 protein in rats after hepatic resection.Methods A hepatectomy model was used to study the ischemia reperfusion injury in hepatic resection.Sprague-Dawley rats were randomly divided into the following three groups:normal control (NC) group,hepatic resection(HR) group,and hypoxia preconditioning (HP) group,there were twenty four rats in each group.HP Group was given an 10％ oxygen-mixed gas for 90 minutes before the operation.At 1,6,12 and 24 hours after the operation,the rats were killed and the following tests were conducted:(1) Liver tissue was sampled to observe the expression of cytochrome C and caspase 3 protein; (2) blood was drawn to conduct a chemical examination; (3) Liver tissue and morphology was observed by transmission electron microscopy.Results The serum levels of ALT and AST in HP group were significantly lower than that of HR group (P＜0.05) at 1,6,12 and 24 hours after the hepatic resection.In each time,liver function of the HP group was significantly better than the HR group; The expression of cytochrome C and caspase 3 protein was decreased significantly in HP group at each measurement point.Hepatic cells in HR group showed typical apoptosis signs under transmission electron microscopy (TEM),but no apoptosis was found in HP group.Conclusion HP has marked inhibition to apoptosis by down-regulating the expression of Cyt C and Caspase-3protein and protection to chondrosomes after a hepatic resection.

Objective To provide the practical experience of association of liver partition and portal vein ligation for staged hepatectomy(ALPPS) procedure in portal vein tumor thrombosis(PVT) cases,and to explore its value in PVTT therapy.Methods Three cases of ALPPS were applied to PVTT in Department of Hepatobiliary Surgery of PLA General Hospital from 2015 to 2016.The patients data were retrieved and analyzed retrospectively,including the basic information,preoperative PVTT classification,preoperative Child-Pugh classification,ICG test results,future liver remnant (FLR),FLR growth rate between 2 phase operation,operation time,bleeding volume,postoperative complications,postoperative survival etc.We discussed the detail technology and discuss the surgical procedure combine our experience and the published papers.Results ALPPS was performed successfully in all 3 patients.According to the Cheng's Classification of PVTT,they were classified as type Ⅱ,1 case and Ⅲ type,2 cases.Preoperative liver function was Child-Pugh A grade,average ICG R15 was 7.3％ (4.2％-11.0％),and average FLR was 387 ml (333-484 ml).The mean time interval between 2 phases surgery was 24.7 days (9-50 days) and the average FLR growth rate was 50.3％ (24.4％-82.3％).Morbidity of Clavien-Dindo Ⅲ or more was recorded in 1 case,but no mortality occurred.During follow-up period,2 patients were treated with TACE for tumor recurrence.All patients survived with acceptable life quality till now.The portal vein tumor thrombosis necrosis was observed in all 3 specimens.Conclusions ALPPS is a valuable surgery for effective control of tumor thrombus and radical resection rate in well selected PVVT type Ⅱ and type Ⅲ patients.It is expected to improve the therapeutic effect in combination with TACE and other treatment methods.

Objective:To investigate the chemical constituents in the rattan of Rubia argyi L.. Methods:The air-dried rattan of Rubia argyi L. was powdered and extracted three times by 75% ethanol with refluxing. After removing the solvent under the reduced pressure,the crude extract was dissolved in water,and then filtrated and extracted by petroleum ether and ethyl acetate to obtain crude extract after removing petroleum ether and ethyl acetate. The compounds were isolated and purified by silica gel column chromatogra-phy,reversed-phase silica gel column chromatography and Sephadex LH-20 gel column chromatography,and then identified based on physicochemical properties and spectral analysis(1 H-NMR and 13C-NMR). Results:Totally 13 compounds were isolated from the rat-tan of Rubia argyi L.,and characterized as secoisolariciresinol(1),xanthopurpurin(2),daucosterol(3),dehydroabietic acid(4), 2-hydroxy-1-methoxy-anthraquinone(5),β-sitosterol(6),lirioresinol A(7),2-hydroxy-7-methyl-9,10-anthraquinone(8),strych-novoline (9), ciwujiatone (10), 3,4-divanillyltetrahydrofuran (11), 2-(4-hydroxypheny) -6-(3-methoxy-4-hydroxyphenyl)-3,7-dioxabicyclo[3,3,0]octane (12), and (6S,9R)-vomifoliol (13).Conclusion: The compounds 1-13 are isolated from the rattan of Rubia argyi L. for the first time and the compounds 1,2,4,5 and 7-13 are first isolated from Rubia L..

Objective:To study the safety and efficacy of a treatment protocol using immune checkpoint inhibitors (ICIs) and antiangiogenic targeted drugs (AATDs) in converting 41 patients with initially unresectable to resectable hepatocellular carcinoma (HCC).Methods:The data of 41 patients with initially unresectable HCC treated with immunotherapy combined with targeted therapy from December 2018 to April 2021 in Chinese PLA General Hospital were analysed. There were 34 males and 7 females, aged (51.8±10.7) years. The clinical characteristics, conversion to resectable HCC, adverse drug reactions, surgical data and postoperative complications were analysed. Patients were followed-up by outpatients clinics or telephone calls.Results:There were 5 patients with Chinese Liver Cancer Staging (CNLC)-Ⅰb, 4 with CNLC-Ⅱ, 28 with CNLC-Ⅲa and 4 with CNLC-Ⅲb before the treatment protocol. Among them, 28 patients had portal vein tumor thrombosis (PVTT) and 4 had retroperitoneal lymph node metastases. All patients had a mean tumor diameter of (9.16±4.43) cm before and (6.49±4.69) cm after the treatment protocol. The latter was based on the last assessment before hepatectomy. The efficacy of the treatment protocol in converting unresectable to resectable HCC was assessed by the modified Response Evaluation Criteria in Solid Tumors after 3-15 cycles (median dose cycles, 5) of protocal therapy: 15 patients achieved a complete response; 15 patients achieved a partial response; 6 patients had a stable disease, and 5 patients had a progressive disease. 21 patients (51.2%) experienced adverse reactions associated with drug treatment, which resolved with symptomatic treatment or brief discontinuation of the therapy. All patients underwent successful hepatectomy. Postoperative complications of grade Ⅱ or higher occurred in 9 patients (22.0%). The cumulative overall survival rates at 6 months, 1 year and 2 years from diagnosis were 100.0%, 92.6% and 64.7% respectively. The cumulative overall survival rates at 6 months, 1 year and 2 years after surgery were 95.1%, 74.7% and 60.8%, and the recurrence-free survival rates at 6 months, 1 year and 2 years after surgery were 87.8%, 56.7% and 48.6%, respectively.Conclusions:This study provided preliminary evidences that surgical resection after immunotherapy combined with targeted therapy in patients with initially unresectable HCC was safe and efficacious.

Objective:To investigate the feasibility of universal newborn hearing screening in countryside in order to provide reliable evidence in launching this program all over the countryside of China. Method:Subjects were 12 638 infants who were born in 9 counties from Jan 2004 to Dec 2005. TEOAE was used for the fast hearing screening. Infants were screened on the 2-7 days after the birth. The re-screening was conducted in 4-6 weeks if failed in the initial screening,and follow-up were provided continually if they also failed in the re-screening. Result; Ten thouand eight hundred and forty-five of 12 638(85. 8%) were screened including 9 963(91. 9%) normal newborns and 882(8. 1%) newborns with high-risk. Seven thouand four hundred and fifty (68. 7%) newborns passed the initial screening, and 3 395 (31. 3%) people failed. One thouand seven hundred and ninty-three (14. 2%) infants were refused to be screened.Only 2 536 (74. 7%) were re-screened on time, and 859(25. 3%) did not receive re-screening. One hundred and twenty were failed in the re-screening or first screening, and 79 (65. 8%)of them received diagnostic assessment. Among the infants received diagnostic assessment, 6(7.6%)ca-ses were found to have profound hearing loss in both ears, 9(11. 4%)cases were found to be severe hearing loss(7 in both ears and 2 in single ear) , 11(13. 9%)cases were found to be moderate hearing loss (5 in both ear and 6 in single ear), 26 (32. 9%) were found to have slight hearing loss (11 in both ear and 15 in single ears), and 27 (34.2%) were normal. Fifty-two infants were diagnosed as hearing loss with a prevalence of congenital hearing loss(in binaural and monaural) of 0. 5%(52/10845)and a prevalence of bilateral hearing loss of 0. 3%(29/10845). A prevalence of congenital hearing loss was 0. 2% (22/9 963) in well infants and 3. 4% (30/882) in high risk infants. Among the 13 cases of children with severe and profound hearing loss in both ears children, 8(61. 5%)cases were fitted with hearing aids and 1 (7. 7%) case was implanted with cochlear implants. Conclusion:It is necessary and feasible to conduct hearing screening program in the rural area. However, the suitable model to perform the program in the countryside needs to be set up as soon as possible in order to get more poor infants to participate into the hearing screening program for free and increase the screening rate.